冠状动脉搭桥术后认知功能障碍的发生率及危险因素分析

Incidence and risk factors of postoperative cognitive dysfunction in patients underwent coronary artery bypass grafting surgery

目的:探讨冠状动脉搭桥术(coronary artery bypass graft,CABG)后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生率及危险因素。方法:选择2013年1月至7月在南京医科大学附属南京医院择期行CABG的患者147例为研究对象。在术前、术后第7天和3个月分别应用精神神经测试量表评估认知功能判定患者是否发生POCD。为计算认知功能评估过程中的学习效应同时征集30名志愿者(患者的家属)完成3次认知功能评估。按照调查表记录患者围术期的年龄、性别、体质量指数、受教育程度、合并症、吸烟饮酒史、美国麻醉师协会(ASA)分级、左室射血分数、手术类别、手术时间、术中脑氧饱和度、术中最低血红蛋白浓度及血红蛋白浓度的下降率、气管导管带管时间、术后疼痛视觉模拟评分(VAS评分)和炎性反应综合征评分(SIRS评分)等,根据是否发生POCD分为POCD组和非POCD组。结果:共有101例患者完成所有3次认知功能测验。术后7 d和3个月分别有38例和21例发生POCD,发生率分别为37.6%和20.8%,其中体外循环下冠状动脉搭桥术(CABG组)患者和非体外循环下冠状动脉搭桥术(OPCABG组)患者在术后7 d及3个月的POCD发生率差异无统计学意义(P>0.05)。多因素logistic逐步回归分析结果表明:高龄(OR=1.177,95%CI 1.071~1.292,P<0.05)、术中血红蛋白浓度的下降率(OR=1.334,95%CI 1.152~1.545,P<0.05)、SIRS评分(OR=2.815,95%CI 1.014~7.818,P=0.047)将增加CABG发生POCD的风险。结论:CABG患者术后7d和3个月的POCD发生率分别为37.6%和20.8%,体外循环下CABG组与OPCABG组术后7 d和3个月的POCD发生率无明显区别。老龄、术中血红蛋白浓度的下降率和SIRS评分是冠状动脉搭桥术患者POCD的独立危险因素。

Objective:To investigate the incidence rate and the risk factors for postoperative cognitive dysfunction(POCD) in patients underwent coronary artery bypass grafting surgery.Methods:A total of 147 patients underwent elective coronary artery bypass grafting(CABG)surgery between January to July 2013 were included in this study.POCD was diagnosed using a neuropsychological test battery.All enrolled patients were interviewed on the day before surgery,the seventh day and 3 months after surgery,respectively,by the same researcher,and were divided into two groups based on the results:the POCD group and the non-POCD group.The information,including age,sex,body mass index,educational status,comorbidities,history of smoking and drinking,ASA grade,left ventricular ejection fraction,operation method,duration of operations,regional cerebral oxygen saturation,the lowest haemoglobin concentrations and the haemoglobin concentration decline rate during the operation,tracheal catheter retention time,postoperative pain on visual analogue scales(VAS) and systemic inflammatory response syndrome score(SIRS score),were recorded based on a schedule of survey.Multivariate logistic regression was used to analyze the risk factors for POCD.Results:A total of 101 patients finished this study.On 7 days and 3 months after surgery,38 and 21 cases showed POCD,with an incidence rate at 37.6%and 20.8%,respectively.Interestingly,there was no significant difference in incidence of POCD between CABG and OPCABG group on both7 days and 3 months after surgery(P>0.05).The logistic stepwise regression analysis indicated that the risk factors for POCD included advanced age(OR=1.177,95%CI 1.071-1.292,P=0.00l),the haemoglobin concentration decline rate(OR=1.334,95%CI 1.152-1.545,P<0.05) and SIRS score(OR=2.815,95%CI 1.014-7.818,P=0.047).Conclusion:The incidence rate of POCD was 37.6%and 20.8%on 7 days and 3 months after surgery respectively.Advanced age,the haemoglobin concentration decline rate and SIRS score are independent risk factors for POCD in patients underwent coronary artery bypass grafting surgery.