局部脑氧饱和度与血浆β-淀粉样蛋白对术后认知功能障碍的影响

Effect of regional cerebral oxygen saturation and plasma amyloidβ-protein on postoperative cognitive dysfunction

目的探讨局部脑氧饱和度(rSO_(2))与血浆β-淀粉样蛋白(Aβ)对术后认知功能障碍(POCD)的影响。方法选取我院收治的择期行心脏手术的患者86例,根据患者是否发生POCD将其分为POCD组与非POCD组。比较2组患者围术期临床资料,并采用多因素Logistic回归分析明确患者发生POCD的独立危险因素,绘制受试者工作特征(ROC)曲线分析rSO_(2)%_(max)、Aβ对POCD的预测价值。结果86例患者中,有29例发生POCD,发生率为33.72%。POCD组与非POCD组患者年龄、受教育程度、冠脉阻断时间、机械通气时间、rSO_(2)%_(max)、Aβ水平比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥55岁、受教育程度为小学及以下、Aβ≤102.45 pg/mL、rSO_(2)%_(max)≤11.15%是患者发生POCD的独立危险因素(P<0.05)。当rSO_(2)%_(max)最佳临界值为10.24%时,预测POCD的曲线下面积(AUC)为0.894(95%CI:0.847~0.951),敏感度和特异度分别为86.21%、82.76%。Aβ最佳临界值为91.85 pg/mL时,预测POCD的AUC为0.902(95%CI:0.851~0.988),敏感度和特异度分别为89.66%、86.21%。二者联合时预测POCD的AUC为0.913(95%CI:0.859~1.000),敏感度和特异度分别为93.10%、89.66%。结论年龄≥55岁、受教育程度为小学及以下、Aβ≤102.45 pg/mL、rSO_(2)%_(max)≤11.15%是心脏手术患者发生POCD的独立危险因素。rSO_(2)%_(max)联合Aβ可提高对POCD的预测效能。

Objective To investigate the effect of regional cerebral oxygen saturation(rSO_(2))and plasma amyloidβ-protein(Aβ)on postoperative cognitive dysfunction(POCD).Methods A total of 86 patients who underwent elective cardiac surgery in our hospital were selected and divided into the POCD group and the non-POCD group according to whether POCD occurred.The perioperative clinical data of the two groups were compared.Multivariate Logistic regression analysis was used to identify the independent risk factors for POCD,and the receiver operating characteristic(ROC)curve were drawn to analyze the predictive value of rSO_(2)%_(max) and Aβfor POCD.Results Among 86 patients,29 patients developed POCD,with an incidence of 33.72%.There were statistically significant differences in age,education level,coronary occlusion time,mechanical ventilation time,rSO_(2)%_(max) and Aβlevel between the POCD group and the non-POCD group(P<0.05).Multivariate Logistic regression analysis showed that age≥55 years old,education level of primary school or below,Aβ≤102.45 pg/mL and rSO_(2)%_(max)≤11.15%were the independent risk factors for POCD in patients(P<0.05).When the optimal critical value of rSO_(2)%_(max) was 10.24%,the area under the curve(AUC)for predicting POCD was 0.894(95%CI:0.847 to 0.951),and the sensitivity and specificity were 86.21%and 82.76%,respectively.When the optimal critical value of Aβwas 91.85 pg/mL,the AUC for predicting POCD was 0.902(95%CI:0.851 to 0.988),and the sensitivity and specificity were 89.66%and 86.21%,respectively.When rSO_(2)%_(max) combined with Aβ,the AUC for predicting POCD was 0.913(95%CI:0.859 to 1.000),and the sensitivity and specificity were 93.10%and 89.66%,respectively.Conclusion Age≥55 years old,education level of primary school or below,Aβ≤102.45 pg/mL and rSO_(2)%_(max)≤11.15%are the independent risk factors for POCD in patients with cardiac surgery.rSO_(2)%_(max) combined with Aβcan improve the predictive efficiency for POCD.