不同统计学指标评价体外循环心内直视术后患者早期认知功能障碍的比较  

Assessment of early postoperative cognitive decline after open cardiopulmonary bypass： comparison of three reliable change indices

作　　者：李显华[1] 张传汉[1] 姚文龙[1] 陈林[1] 王建伟[1] 田玉科[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉学教研室,武汉市430030

出　　处：《中华麻醉学杂志》2007年第2期156-159,共4页Chinese Journal of Anesthesiology

摘　　要：目的 通过神经心理测验观察体外循环心内直视术前、术后患者认知功能的变化，比较不同统计学指标评价体外循环心内直视术后早期认知功能障碍的发生率，为临床应用提供参考。方法 择期体外循环心内直视术患者47例，ASAⅡ或Ⅲ级，年龄15～45岁。分别在术前第1天和术后第7天行神经心理测验。另选取健康志愿者40名，间隔7d行神经心理测验2次，作为对照，采用标准差指数（SDI）、可信改变指数（RCI）和改良可信改变指数（MRCI）评价各项测验中认知功能损害的发生率及总认知功能障碍的发生率。结果 采用SDI、RCI和MRCI判断的总认知功能障碍发生率分别为14．9％、8．5％、19．1％，差异有统计学意义（P〈0．05）。与SDI比较，视觉再生测验中RCI和MRCI评价的认知功能损害发生率降低，数字符号测验中MRCI评价的认知功能损害发生率升高（P〈0．05）；与MRCI比较，数字符号测验中SDI、RCI评价的认知功能损害发生率降低（P〈0．05）。结论 对体外循环心内直视术患者，MRCI是分析术后早期认知功能较合理的统计学指标。Objective To compare 3 different statistical methods in the assessment of the incidence of early postoperative cognitive impairment after open heart surgery performed under cardiopulmonary bypass （CPB）. Methods Forty-seven ASA Ⅱ - Ⅲ patients aged 15-45 yr scheduled for open heart surgery with CPB were enrolled in this study. Neuropsychologic assessment was performed before and at 7 days following cardiac surgery. A matched control group of 40 normal subjects who were examined twice over a similar interval. Standard deviation index （SDI）, reliable change index （RCI） and modified reliable change index （MRCI） were calculated for each neuropsychologic measure. The overall incidence of postoperative cognitive decline among the patients studies was determined using these indices. Results The incidence of cognitive decline as assessed by 2 of 6 neuropsychologic tests was significantly different using SDI, RCI and MRCI. The overall incidence of postoperative cognitive decline as determined by using SDI, RCI and MRCI was 14.9%, 8.5% and 19.1% respectively.Conclusion MRCI could be a more reasonable statistical method for assessment of postoperative cognitive decline in patients after open heart surgery under cardiopulmonary bypass.

关 键 词：统计学 认知障碍 心肺转流术 心脏外科手术 神经心理学测验 手术后 间期 

分 类 号：R686[医药卫生—骨科学]