冠状动脉旁路移植术后病人谵妄和认知功能障碍的危险因素分析  

Analysis of risk factors of delirium and cognitive dysfunction after off-pump coronary artery bypass grafting

作　　者：易莉莎[1] 姚尚龙[1] 陈向东 武庆平[1] 黄梦玉[1] 王婷婷 石琴芳 郭超 YI Lisha;YAO Shanglong;CHEN Xiangdong(Department of Anesthesiology,Union Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉科,430022 [2]华中科技大学同济医学院附属协和医院心外科,430022

出　　处：《临床外科杂志》2018年第12期925-928,共4页Journal of Clinical Surgery

摘　　要：目的探讨冠状动脉旁路移植术(coronary artery bypass grafting,CABG)术后病人认知功能障碍的危险因素。方法按照预设的纳入标准,入选2012年3月～2013年3月在我院行CABG治疗的病人80例,收集病人术前、术中及术后恢复情况。用重症监护室意识模糊评估法(confusion assessment method for the ICU,CAM-ICU)评价CABG病人术前1天和术后1～3天的谵妄情况。用简易智能状态量表(mini-mental state examination,MMSE)评价病人术前1天和术后第7天的认知功能情况。结果术后3天共有17例病人(21. 25%)发生谵妄,单因素分析显示,年龄、卒中史、停跳时间、术后视觉模拟评分(visual analogue score,VAS)、低心排综合征和术前MMSE是术后谵妄发生的危险因素,多因素Logistic回归分析表明,年龄> 65岁、有卒中史、停跳时间过长、术后VAS评分较高、低心排综合征和术前MMSE评分较低是CABG病人发生谵妄的独立危险因素。术后7天共有25例(31. 25%)病人发生认知功能障碍,单因素分析显示,年龄、高血压病史、糖尿病病史、停跳时间、术中氧饱和度、术后VAS评分、低心排综合征和术前MMSE是术后认知功能障碍的危险因素,多因素Logistic回归分析表明,年龄> 65岁、停跳时间过长、糖尿病、术后VAS评分较高、低心排综合征和术前MMSE评分较低是CABG病人发生认知障碍的独立危险因素。结论年龄> 65岁、有卒中史、停跳时间过长、糖尿病、术后VAS评分较高、低心排综合征和术前MMSE评分较低等因素对CABG病人发生谵妄和认知障碍有预测价值。Objective To explore the risk factor of cognitive function after coronary artery bypass grafting( CABG). Methods According to the inclusive criteria setted before the research,we gathered relevant data of pre-operation,post-operation,and recovery condition after operation of 80 patients with CABG in our hospital from March 2012 to March 2013 before operation. Delirium one day before operation and the first to the third day after operation were assessed with CAM-ICU. Cognitive function one day before operation and the seventh day after operation were assessed with MMSE. Results There were 17 patients( 21. 25%) developed postoperative delirium during 3 days after operation. Univariate analysis showed that age,stroke history,time to stop jumping,visual analogue score( VAS),hypocardia syndrome and preoperative MMSE were risk factors for postoperative delirium. Multivariate Logistic regression analysis showed that older than 65 years old,stroke history,too long time of cardiac arrest,higher postoperative VAS score,low cardiac output syndrome and lower preoperative MMSE score were independent risk factors in patients undergoing CABG surgery developed delirium. On the seventh day after operation,there were25 patients( 31. 25%) developed cognitive dysfunction. Univariate analysis showed that age,history of hypertension,history of diabetes,duration of arrest,intraoperative oxygen saturation,postoperative VAS score,hypocardia syndrome and preoperative MMSE were risk factors for postoperative cognitive dysfunction. Multivariate Logistic regression analysis showed that older than 65 years old,too long time for cardiac arrest,diabetes,higher postoperative VAS score,low cardiac output syndrome and lower preoperative MMSE score were independent risk factors for patients undergoing CABG developed cognitive disorders.Conclusion Older than 65 years old,history of stroke,too long time of cardiac arrest,diabetes,higher postoperative VAS score,low cardiac output syndrome and lower preoperative MMSE score were risk factors for patient

关 键 词：冠状动脉移植术 谵妄 术后认知功能障碍 

分 类 号：R654.2[医药卫生—外科学]