急性冠状动脉综合征患者择期PCI术后认知功能障碍的影响因素分析  

Influencing factor of postoperative cognitive dysfunction in patients with acute coronary syndrome undergoing elective PCI

作　　者：张奕[1] ZHANG Yi(Department of Critical Care Medicine,Chengdu Third People's Hospital,Chengdu 610014,China)

机构地区：[1]成都市第三人民医院重症医学科

出　　处：《中国医学前沿杂志（电子版）》2019年第10期95-98,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：2016年度四川省医学会重症医学（宜昌人福）专项[2016ZZ002（YCRF）]

摘　　要：目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者行择期经皮冠状动脉介入治疗(percutaneouscoronary intervention,PCI)后发生术后认知功能障碍(postoperative cognitive dysfunction,POCD)的影响因素。方法选择2017年1月至2018年8月于本院拟行择期PCI手术的130例ACS患者为研究对象,采用蒙特利尔认知评估量表(Montrealcognitive assessment scale,MoCA)评估患者术后2周的认知功能,将MoCA评分< 26分的患者纳入POCD组,其余患者纳入非POCD组。比较两组患者的临床资料,采用多因素Logistic回归分析探讨ACS患者择期PCI术后发生POCD的独立危险因素。结果 130例ACS患者择期PCI术后2周时有35例患者发生POCD,发生率为26.9%。POCD组年龄≥65岁、高中及以上文化程度、高血压病史、手术时间≥ 60 min、胸痛至开通血管时间≥ 6h、术后低氧血症患者占比均显著高于非POCD组(均P<0.05),术前使用右美托咪定患者占比显著低于非POCD组(P<0.05)。多因素Logistic回归分析结果显示,年龄≥ 65岁、术后低氧血症是ACS患者择期PCI术后发生POCD的独立危险因素(均P<0.05),而术前使用右美托咪定是其独立保护因素(P<0.05)。结论约1/4的ACS患者择期PCI术后可出现认知功能损害,高龄、术后低氧血症是发生POCD的独立危险因素,而术前使用右美托咪定能降低POCD发生风险。Objective To investigate the influencing factor of postoperative cognitive dysfunction (POCD) in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI). Method 130 patients with ACS who underwent elective PCI in our hospital from January 2017 to August 2018 were enrolled for the study. The cognitive function was assessed by Montreal cognitive assessment scale (MoCA) at 2 weeks after operation, and patients were divided into POCD group (MoCA score < 26 points) and non-POCD group (MoCA score ≥ 26 points). The clinical data of the two groups were compared, and multivariate Logistic regression analysis was used to investigate the independent influencing factors of POCD in patients with ACS underwent elective PCI. Result Among the 130 patients with ACS, POCD occurred in 35 patients at 2 weeks after elective PCI, with an incidence of 26.9%. The proportions of age ≥ 65 years old, high school and above education level, history of hypertension, operation time ≥ 60 min, time from chest pain to vascular opening ≥ 6 hours, postoperative hypoxemia in POCD group were significantly higher than those in non-POCD group (all P < 0.05), and the proportion of preoperative application of Dexmedetomidine was significantly lower than that in non-POCD group (P < 0.05). Multivariate Logistic regression analysis showed that age ≥ 65 years old and postoperative hypoxemia were the independent risk factors for POCD (all P < 0.05), while preoperative application of Dexmedetomidine was an independent protective factor (P < 0.05). Conclusion About 1/4 of ACS patients suffered from POCD after elective PCI. Advanced age and postoperative hypoxemia are the independent risk factors for POCD, while preoperative application of Dexmedetomidine can reduce the risk.

关 键 词：术后认知功能障碍 经皮冠状动脉介入术 急性冠状动脉综合征 蒙特利尔认知评估量表 

分 类 号：R541.4[医药卫生—心血管疾病] R749.2[医药卫生—内科学]