心脏瓣膜置换术后早期认知功能障碍相关危险因素研究  

Risk factors for early postoperative cognitive dysfunction after cardiac valve replacement

作　　者：许涛[1] 赵珍珍[1] 王嘉峰[1] 朱文忠[1] 王军[2] 

机构地区：[1]第二军医大学附属长海医院麻醉科,上海200433 [2]第二军医大学附属长海医院胸心外科,上海200433

出　　处：《中国体外循环杂志》2013年第2期92-95,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的观察和评测体外循环下心脏瓣膜置换术后早期术后认知功能障碍,统计相关发生率并分析其相关临床危险因素。方法连续观测行无代谢性疾病及神经系统疾病心脏瓣膜置换术患者90例。收集患者的一般信息、教育程度、原发性高血压病病史、ASA分级、心脏功能分级、术前心脏射血分数、主动脉阻断开放体位、手术时间、麻醉时间、体外循环时间、阻断时间、复温时间及麻醉药物种类和使用剂量等参数,采用简易智力心理量表(MMSE)评分方法对患者进行术前和术后评分。术前术后MMSE评分下降2分及以上的患者为术后认知功能障碍,所有数据录入SPSS14.0行logistic多因素统计分析,P<0.05为统计学意义上有显著差异。结果多因素分析显示,年龄OR值为1.34(1.01～1.78,95%CI),阻断时间OR值为2.17(1.09～4.32,95%CI),七氟烷吸入浓度OR值为0.505(0.34～0.74,95%CI),均具有显著统计学意义(P<0.05)。结论年龄和主动脉阻断时间是体外循环下心脏瓣膜置换术术后早期认知功能障碍的相关危险因素。七氟烷在临床应用浓度下,随吸入浓度的提高,术后认知功能障碍的发生率呈下降趋势。Objective To elucidate relative clinical independent risk factors for postoperative cognitive dysfunction （POCD） after cardiac valve replacement. Methods Clinical research was consecutively conducted in cardiac valve replacement. The patients who had metabolism syndrome and/or history of neurologic deficits were excluded. Minimal mental state examination （MMSE） was a- dapted to evaluate the cognitive function of patient preoperatively and postoperatively. Patients who had MMSE decline I〉 2 were thought to be POCD. Information of the patients was recorded, including general information, education state, hypertension, ASA, classification of heart failure, ejection fraction, head - down position, surgery time, anesthesia time, on pump time, aortic cross - clamp time, rewarming time and anesthetic dosage. Variants were enrolled into multifactor analysis for which single factor analysis was significantly （ P 〈 0.1 ）. Logistic regression analysis was employed for multifactor analysis in risk factors on POCD. Results Logistic regression analysis revealed that OD of age, aortic cross - clamp time, sevoflurane were 1.34 （ 1.01 - 1.78, 95% CI） , 2.17 （ 1.09 -4.32, 95% CI） and 0.505 （0.34 -0.74, 95% CI） respectively （ P 〈0.05）. Conclusion This part of trial suggested that age and aoric cross - clamp time are both independent risk factor for POCD after cardiac valve replacement. And sevoflurane under the clin- ical use concentration provide prevention to POCD with concentration dependent effect.

关 键 词：体外循环 术后认知功能障碍 心脏瓣膜置换术 七氟烷 

分 类 号：R654.2[医药卫生—外科学]