冠状动脉搭桥术后患者认知功能障碍的发生现况及其相关影响因素探讨

Current Status and Related Influencing Factors of Cognitive Impairment in Patients After Coronary Artery Bypass Grafting Surgery

目的探讨冠状动脉搭桥术后患者认知功能障碍的发生现况及其相关影响因素。方法对2021年1月—2022年12月在郑州大学第一附属医院接受治疗的445例冠状动脉搭桥术后患者临床资料进行回顾性分析,将发生认知功能障碍的患者纳入障碍组(术后第7天采用简易精神状态评价量表评估认知功能,显示评分<27分),无认知功能障碍的患者纳入无障碍组。统计冠状动脉搭桥术后患者认知功能障碍的发生现况,比较两组临床资料,予以Lasso回归分析法分析冠状动脉搭桥术后患者认知功能障碍的危险因素,并构建预测模型,绘制受试者操作特征曲线分析其对冠状动脉搭桥术后患者认知功能障碍的预测价值。结果445例冠状动脉搭桥术后患者中有54例简易精神状态评价量表评分<27分,认知功能障碍发生率为12.13%。障碍组年龄大于无障碍组;气管导管带管时间、加强监护病房停留时间长于无障碍组;on-pump术、有高血压、镇静药使用、肾功能异常、重度冠状动脉狭窄的患者占比分别为61.11%、40.74%、57.41%、59.26%、24.07%,均高于无障碍组的46.55%、18.16%、19.44%、26.60%、5.11%;全身炎症反应综合征评分、血清肿瘤坏死因子-α、肿瘤坏死因子受体Ⅱ水平高于无障碍组(P<0.05)。Lasso回归分析结果显示,年龄大、加强监护病房停留时间长、伴高血压、全身炎症反应综合征评分高、血清肿瘤坏死因子-α水平高以及冠状动脉狭窄程度为重度均是冠状动脉搭桥术后患者认知功能障碍的独立危险因素。回归方程模型:logit(P)=-15.827+年龄×0.07+加强监护病房停留时间×0.024+有无高血压×1.586+全身炎症反应综合征评分×1.126+血清肿瘤坏死因子-α水平×0.16-冠状动脉狭窄程度中度×0.238+冠状动脉狭窄程度重度×1.631。受试者操作特征曲线分析显示,当logit(P)>0.16时,曲线下面积为0.873,95%CI为0.814~0.933,诊断敏感度为74.07%,特异度为88.00%。结论冠状动脉搭桥术后患者认知功能障碍的风险较高,其独立危险因素包括年龄大、加强监护病房停留时间长、有高血压、全身炎症反应综合征评分高、血清肿瘤坏死因子-α水平高以及冠状动脉狭窄程度为重度,根据其构建回归模型的预测价值较高,临床可据此给予针对性的预防及治疗措施。

Objective To explore the current status and related influencing factors of cognitive impairment in patients after coronary artery bypass grafting.Methods The clinical data of 445 patients after coronary artery bypass grafting admitted to The First Affiliated Hospital of Zhengzhou University from January 2021 to December 2022 were retrospectively analyzed.Patients with cognitive impairment were included in the obstacle group(on the 7 th postoperative day,cognitive function was evaluated using the simplified mental state assessment scale,with a score of<27 points),while patients without cognitive impairment were included in the non obstacle group.The current status of cognitive dysfunction in patients after coronary artery bypass grafting was analyzed,the clinical data of two groups were compared,the risk factors of cognitive dysfunction in patients after coronary artery bypass grafting was analyzed by Lasso regression analysis,and constructed a predictive model,and its predictive value for cognitive dysfunction in patients after coronary artery bypass grafting analyzed by the receiver operating characteristic curve.Results Among 445 patients after coronary artery bypass grafting,54 had a score of simplified mental state assessment scale<27,and the incidence of cognitive impairment was 12.13%.The age of the disabled group was greater than that of the non obstacle group;the times of duration of tracheal intubation and intensive care unit stay were longer than those in the non obstacle group;the proportion of patients with on-pump surgery,hypertension,sedative drug use,renal dysfunction,and severe coronary stenosis was 61.11%,40.74%,57.41%,59.26%and 24.07%,respectively,which were higher than 46.55%,18.16%,19.44%,26.60%and 5.11%in the non obstacle group;the score of postoperative systemic inflammatory response syndrome,levels of serum tumor necrosis factor-α,tumor necrosis factor receptorⅡwere higher than that of the non obstacle group(P<0.05).The results of Lasso regression analysis showed that older age,longer intensive care unit stay,hypertension,high score of systemic inflammatory response syndrome,high levels of serum tumor necrosis factor-αand severity of coronary stenosis were independent risk factors for cognitive impairment in patients after coronary artery bypass grafting surgery.The regression equation model:logit(P)=-15.827+age×0.07+time of intensive care unit stay×0.024+with or without hypertension×1.586+score of systemic inflammatory response syndrome×1.126+level of serum tumor necrosis factor-α×0.16-moderate degree of coronary stenosis×0.238+severe degree of coronary stenosis×1.631.Receiver operating characteristic curve analysis showed that when logit(P)>0.16,the AUC value was 0.873,with 95%CI 0.814~0.933,the diagnostic sensitivity was 74.07%,and the specificity was 88.00%.Conclusion The risk of cognitive impairment in patients after coronary artery bypass grafting was higher,and the independent risk factors included older age,longer stay in intensive care unit,high blood pressure,high score of systemic inflammatory response syndrome,high level of serum tumor necrosis factor-α,and severe coronary stenosis,the predictive value of constructing regression models based on it was high,and targeted prevention and treatment measures could be given in clinical practice.