体外循环术后12例认知功能障碍原因分析与处理  

Analysis of the reasons to cause cognitive dysfunction after cardiopulmonary bypass in 12 patients and treatment

作　　者：王蓉[1] 董爱萍[1] 沈述威[1] 向强[1] 杨小文[1] 

机构地区：[1]华中科技大学同济医学院附属荆州医院,湖北荆州434020

出　　处：《齐鲁护理杂志（下旬刊）》2010年第12期18-19,共2页Journal of Qilu Nursing

摘　　要：目的:探讨体外循环心脏直视术患者术后出现认知功能障碍的原因及处理方法。方法:对12例体外循环下行心脏直视术后发生认知功能障碍患者的临床资料、CPB情况及处理方法作一回顾性研究。结果:12例出现认知功能障碍的患者中:3例患者CPB开始后出现平均动脉压持续低于40 mm Hg(1 mm Hg=0.133 kPa)30 min;4例患者术前彩色多普勒监测存在动脉粥样硬化伴颈总动脉狭窄;3例患者手术后曾因低心排出现平均动脉压长时间低于70 mm Hg;另2例患者无明显术后认知功能障碍诱发因素。12例患者经维持血流动力学稳定,纠正水、电解质紊乱及酸碱平衡失调,高压氧治疗,以及镇静等对症支持治疗后均痊愈出院。结论:体外循环下行心脏直视手术需加强脑保护,出现术后认知功能障碍的症状后应积极对症处理、维持血流动力学的稳定、同时积极行高压氧治疗以及时恢复患者脑功能。Objective： To analyze the reasons to cause cognitive dysfunction after open heart surgery with cardiopulmonary bypass and find proper treatment.Methods： The retrospective study was made on the clinical data and information of 12 patients with cognitive dysfunction after open heart surgery with cardiopulmonary bypass,CPB conditions and treatment.Results： Among 12 patients,the mean arterial blood pressure was consistently below 40 mm Hg 30 minutes when CPB began in 3 patients;4 patients had atherosclerosis associated with carotid artery stenosis diagnosed by color Doppler monitoring before surgery;the mean arterial pressure was below 70 mm Hg for a long time in 3 patients because of low cardiac output and no obvious predisposing factors of postoperative cognitive dysfunction was found in the other 2 patients.All the patients were cured and recovered after they were treated with comprehensive measures,such as maintaining hemodynamic stability,correcting water and electrolyte disorders and acid-base balance disorders,hyperbaric oxygen therapy as well as sedation and other symptomatic and supportive treatment.Conclusion： Much attention should be paid to the protection of the patient＇s brain function when open heart surgery was performed with cardiopulmonary bypass and the symptomatic treatment should be actively implemented when postoperative cognitive dysfunction occurred in the patients,like maintaining hemodynamic stability and hyperbaric oxygen therapy.

关 键 词：体外循环 心脏外科手术 认知功能障碍 

分 类 号：R473.6[医药卫生—护理学]