脑灌注异常与冠状动脉旁路移植术后认知功能障碍的关系  

Impaired cerebral perfusion as an independent risk factor for cognitive dysfunction after coronary artery bypass grafting

作　　者：李俊玉[1] 毕齐[2] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所,北京100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所神经内科,北京100029

出　　处：《心肺血管病杂志》2013年第4期466-469,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都医学发展科研基金(2009-2075);北京市科技计划(Z111107058811013)

摘　　要：目的:研究非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OP-CABG)术前脑灌注异常与术后认知功能障碍(postoperative cognitive dysfunction,POCD)的关系。方法:选择择期行OPCABG的患者364例,术前用320排动态容积CT评估患者是否存在脑灌注异常,将患者分为脑灌注正常组与脑灌注异常组。术前及术后7 d采用简明精神状态量表(mini mental state examina-tion,MMSE)及蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)评估患者认知功能,判断患者术后是否发生了POCD,比较脑灌注正常组与脑灌注异常组POCD的发生率有无差别。结果:术前有76例(20.8%)的患者存在脑灌注异常,脑灌注异常组POCD发生率明显高于无脑灌注异常组(26.3%vs.9.7%,P<0.001)。各脑灌注参数中,术前颞叶最大峰值时间(time-to-peak,TTP)对POCD的预测作用最强,曲线下面积为(0.664,95%CI:0.577～0.752,P<0.001)。结论:术前脑灌注异常是OPCABG后POCD发生的危险因素。各脑灌注参数中,TTP对POCD的预测作用最强。Objective：To analyze the relationship between impaired cerebral perfusion and the incidence of postoperative cognitive dysfunction（POCD） after off-pump coronary artery bypass gratting（OPCABG）.Methods： This study included 364 cases undergoing OPCABG.Before surgery,the 320 row dynamic volume CT was used to determine if the cerebral perfusion is impaired.Each patient was evaluated with Mini Mental State Examination（MMSE） and Montreal Cognitive Assessment（MoCA） 24 hours before and 7 days after surgery.The incidence of POCD was compared between the patients with impaired cerebral perfusion and those without impaired cerebral perfusion.Results：76 patients（20.8%） were found to have impaired cerebral perfusion and they had a higher rate of POCD when compared with the counterparts（26.3% vs.9.7%,P0.001）.The temporal lobe time-to-peak（TTP） was a better predictor of the occurrence of POCD,with a（ROC=0.664,95%CI：0.577~0.752;P0.001）.Conclusion： Impaired baseline cerebral perfusion is a risk factor for POCD after OPCABG.Compared to other parameters,TTP was the best predictor for POCD.

关 键 词：脑灌注 冠状动脉旁路移植术 认知功能障碍 

分 类 号：R54[医药卫生—心血管疾病]