非体外循环下冠状动脉旁路移植术后焦虑抑郁相关危险因素分析  

Risk factor analysis of anxiety/depression after off-pump coronary artery bypass grafting

作　　者：许保磊[1] 毕齐[1] 陈明盈[1] 乔秋博[1] 骆迪[1] 

机构地区：[1]首都医科大学附属北京安贞医院神经内科,100029

出　　处：《中国医药》2015年第7期975-978,共4页China Medicine

基　　金：首都医学发展科研基金（2009-2075）

摘　　要：目的 探讨非体外循环下冠状动脉旁路移植术（OPCABG）后焦虑抑郁的相关危险因素.方法 收集2010年8月至2013年9月首都医科大学附属北京安贞医院住院行OPCABG的患者813例,术前对患者一般情况进行统计并完善术前检查,并对患者进行颈动脉超声及320排CT检查评估患者脑血管功能,包括头部320排CT平扫及CT灌注成像;术后7d再次对患者进行神经系统功能评估,判断术后是否出现焦虑抑郁.根据术后是否出现焦虑抑郁将患者分为焦虑抑郁组与非焦虑抑郁组,对比分析术后焦虑抑郁的危险因素,并探讨各因素与术后焦虑抑郁的关系.结果 焦虑抑郁组67例,非焦虑抑郁组746例.术后神经系统并发症总发生率为23.4％（190/813）,其中术后焦虑抑郁状态为8.2％ （67/813）,脑梗死为1.1％ （9/813）,缺血缺氧性脑病为2.3％ （19/813）,谵妄为1.5％ （12/813）,术后认知功能障碍为12.9％ （105/813）.非焦虑抑郁组患者受教育程度、糖尿病史、颈动脉超声狭窄与焦虑抑郁组比较[文盲：7.4％ （55/746）比16.4％（11/67）,小学：19.3％ （144/746）比25.4％（17/67）,中学：52.1％（389/746）比40.3％ （27/67）,大学或大学以上：21.2％ （158/746）比17.9％（12/67）;糖尿病史：31.2％（233/746）比44.8％（30/67）;重度狭窄：9.7％ （72/746）比19.4％ （13/67）,轻中度狭窄：90.3％ （674/746）比80.6％（54/67）],差异均有统计学意义（均P＜0.05）.Logistic多因素回归分析显示,受教育程度低为术后焦虑抑郁发生的独立危险因素（比值比=1.85,95％置信区间：1.26 ～2.12）.结论 受教育程度是OPCABG术后焦虑抑郁状态的独立危险因素.Objective To investigate the risk factors for anxiety/depression after off-pump coronary artery bypass grafting （OPCABG）.Methods Totally 813 patients who underwent OPCABG from August 2010 to September 2013 were enrolled.The general data before operation were recorded,the preoperative examinations were performed,the preoperative cerebrovascular function were assessed by carotid ultrasound and 320-slice CT （CT and perfusion CT imaging）.Neural function was assessed before and 7 days after operation,and the patients were assigned into anxiety/depression group and non-anxiety/depression group.The risk factors of anxiety/depression after operation were analyzed.Results There were 67 cases in anxiety/depression group and 746 cases in non-anxiety/depression group.The total incidence of neurological complications after operation was 23.4% （190/813）,including anxiety/depression [8.2% （67/813）],cerebral infarction [1.1% （9/813）],hypoxic ischaemic encephalopathy [2.3% （19/813）],delirium [1.5% （12/813）],and postoperative cognitive dysfunction [12.9% （105/813）].Anxiety/depression group had a lower degree of education,higher proportion of diabetes and more severe extracranial carotid artery stenosis compared with non-anxiety/depression group [illiterate：7.4% （55/746） vs 16.4% （11/67）,primary school：19.3% （144/746） vs 25.4% （17/67）,middle school：52.1% （389/746） vs 40.3% （27/67）,university or above：21.2% （158/746） vs 17.9% （12/67）;diabetes：31.2% （233/746） vs 44.8% （30/67）;severe stenosis：9.7% （72/746） vs 19.4% （13/67）,mild to moderate stenosis：90.3% （674/746） vs 80.6% （54/67）] （P 〈 0.05）.Logistic regression analysis showed that the education was an independent risk factor for anxiety/depression （odds ratio =1.85,95% confidence interval =1.26-2.12）.Conclusion Education is an independent risk factor of anxiety/depression after OPCABG.

关 键 词：冠状动脉旁路移植术 非体外循环 焦虑抑郁 并发症 危险因素 

分 类 号：R654.2[医药卫生—外科学]