冠状动脉搭桥术后患者并发认知功能障碍的危险因素

The risk factors of cognitive dysfunction on patients with coronary heart disease after coronary artery bypass grafting

目的探讨冠状动脉搭桥术后患者并发认知功能障碍(POCD)的危险因素。方法选择2019年1月~2021年1月我院收治的110例采用冠状动脉搭桥术治疗的冠心病患者为研究对象,术后采用简易精神状态评价量表(MMSE)进行POCD筛查,并设为POCD组与非POCD组。比较两组患者年龄、合并糖尿病等一般资料以及手术时间、术中脑氧饱和度(rSO2)变化率等手术资料,先后运用单因素与多因素回归分析探讨术后并发POCD的危险因素。结果110例冠状动脉搭桥术后26例患者并发POCD,发生率23.64%;POCD组与非POCD组在年龄、合并糖尿病、术中rSO_(2)变化率、体外循环、术前焦虑、ICU时间差异具有统计学意义(P<0.05),两组性别、受教育程度、手术时间差异无统计学意义(P>0.05);多因素Logistic回归分析显示,年龄>70岁、术中rSO_(2)变化率30%、体外循环、术前焦虑、ICU时间7d是冠状动脉搭桥术后并发POCD的独立危险因素。结论冠状动脉搭桥术后POCD发生率较高,与年龄、rSO_(2)变化、体外循环等因素有关。

Objective To explore the risk factors of cognitive dysfunction(POCD)on patients with coronary heart disease after coronary artery bypass grafting.Methods A total of 110 patients with coronary heart disease treated with coronary artery bypass graft surgery in our hospital from January 2019 to January 2021 were selected as the research objects.After the operation,the Simple Mental State Evaluation Scale(MMSE)was used for POCD screening,and the POCD group and the non-POCD group were set.The two groups of patients were compared with general data such as age and diabetes,as well as surgical data such as operation time and intraoperative cerebral oxygen saturation(rSO2)change rate.Single-factor and multi-factor analysis were used to investigate the risk factors of postoperative POCD.Results POCD occurred in 26 of 110 patients after coronary artery bypass grafting,with an incidence of 23.64%.There was significant difference in age,diabetes,intraoperative rSO_(2) change,cardiopulmonary bypass,preoperative anxiety and ICU time between group POCD and non POCD group(P<0.05).There was no significant difference in gender,education and operation time between the two groups(P>0.05).Multivariate logistic regression analysis showed that age>70 years old,intraoperative change rate of rSO_(2)>30%,cardiopulmonary bypass,preoperative anxiety and ICU time>7 days were independent risk factors for POCD after coronary artery bypass grafting.Conclusion The incidence of POCD in patients with coronary heart diseaseafter coronary artery bypass grafting is high,which is related to age,changes of rSO_(2),cardiopulmonary bypass and other factors.