风湿性二尖瓣狭窄患者经皮球囊二尖瓣成形术后认知功能损害的影响因素及其对康复的影响  

Influencing factors of cognitive inpairment in patients with rheumatic mitral stenosis after percutaneous balloon mitral valvuloplasty and their influence on rehabilitation

作　　者：马小丹 何瑞香 刘慧 贾莎莎 Ma Xiaodan;He Ruixiang;Liu Hui;Jia Shasha(Department of Cardiac Surgery,Xijing Hospital First Affiliated to Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院西京医院心外科,西安710032

出　　处：《中国医学前沿杂志（电子版）》2021年第7期123-127,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨风湿性二尖瓣狭窄(rheumatic mitral stenosis,RMS)患者经皮球囊二尖瓣成形术(percutaneous balloon mitral valvuloplasty,PBMV)术后认知功能损害的影响因素及其对康复的影响。方法选取2019年1月至2020年8月于空军军医大学第一附属医院择期行PBMV的106例RMS患者为研究对象,根据蒙特利尔认知评估(Montreal cognitive assessment,MoCA)量表评分将患者分为认知功能损害组和认知功能正常组。比较两组患者一般临床资料、手术时间、术中低血压、谵妄发生率、重症监护病房住院天数,以及手术前后超声心动图检查指标和健康调查量表36(36-item short form health survey,SF-36)评分的改善。结果全部患者术后3 d MoCA量表视空间与执行功能、注意力、延迟回忆、定向力的维度评分与总分均显著低于术前(均P<0.05),其中20例(18.9%)患者术后出现认知功能损害。认知功能损害组患者年龄、合并心房颤动比率、Wilkins评分、左心房内径(left atrial diameter,LAD)均显著高于认知功能正常组(均P<0.05),平均年收入、受教育年限、二尖瓣瓣口面积(mitral valve area,MVA)均显著低于认知功能正常组(均P<0.05)。认知功能损害组患者手术前后LAD、MVA及SF-36总分的改善率均显著低于认知功能正常组(均P<0.05)。结论RMS患者PBMV术后认知功能常出现不同程度的损害,认知功能损害与年龄、合并心房颤动、Wilkins评分等多个因素有关,认知功能损害能影响患者的短期疗效及生存质量,值得临床重视。Objective To investigate the influencing factors of cognitive inpairment in patients with rheumatic mitral stenosis(RMS)after percutaneous balloon mitral valvuloplasty(PBMV)and their influence on rehabilitation.Method A total of 106 patients with RMS undergoing PBMV in Xijing Hospital First Affiliated to Air Force Military Medical University from January 2019 to August 2020 were prospectively selected as the research objects.According to the score of Montreal cognitive assessment(MoCA)scale,the patients were divided into impaired cognitive group and normal cognitive group.The general clinical data,operative time,incidence of intraoperative hypotension and delirium,intensive care unit hospitalization days,improvement rate of echocardiography and 36-item short form health survey(SF-36)scores before and after surgery were compared between the two groups.Result The scores of visual space and executive function,attention,delayed recall,orientation and total scores of MoCA scale at 3 days after operation were significantly lower than those before operation(all P<0.05).Among them,20 patients(18.9%)suffered from postoperative cognitive impairment.The age,incidence of atrial fibrillation,Wilkins score and left atrial diameter(LAD)before operation of impaired cognitive group were significantly higher than those of normal cognitive group(all P<0.05),and the average annual income,education time and mitral valve area(MVA)before operation of impaired cognitive group were significantly lower than those of normal cognitive group(all P<0.05).The improvement rate of LAD,MVA and SF-36 total score before and after operation of impaired cognitive group were significantly lower than those of normal cognitive group(all P<0.05).Conclusion The cognitive function of RMS patients after PBMV is often impaired in varying degrees.Cognitive impairment was associated with age,atrial fibrillation,Wilkins score and so on.Cognitive impairment can affect the short-term efficacy and quality of life of patients,which is worthy of clinical attention.

关 键 词：术后认知功能损害 风湿性二尖瓣狭窄 经皮球囊二尖瓣成形术 蒙特利尔认知评估量表 

分 类 号：R654.2[医药卫生—外科学]