心脏移植术后中期认知功能障碍发生率与相关影响因素研究  

Incidence and Related Risk Factors of Mid-term Postoperative Cognitive Impairment After Heart Transplantation

作　　者：熊倜修思 严威源 王怡轩[1] 王国华[1] 史嘉玮[1] 陈思[1] 董念国[1] XIONG Tixiusi;Wai Yen YIM;WANG Yixuan;WANG Guohua;SHI Jiawei;CHEN Si;DONG Nianguo(Cardiovascular Surgery Department,Union Hospital,Tongji Medical College,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心脏大血管外科,武汉430022

出　　处：《中国循环杂志》2025年第4期352-358,共7页Chinese Circulation Journal

基　　金：国家自然科学基金(82001701);湖北省重点研发计划(2020BCA061)。

摘　　要：目的:探索心脏移植受者术后中期单次测评诊断的认知功能障碍发生率与相关影响因素。方法:本研究纳入2019年5月至2019年10月期间在本中心心脏移植门诊复查的成年患者共132例。所有患者的心脏移植、麻醉、体外循环、免疫抑制等管理方案均由同一心脏移植团队实施。采用中国修订版简易智能精神状态量表(MMSE)和蒙特利尔认知评估量表北京版(MoCA)两个神经心理筛查量表对患者进行测评并诊断认知功能障碍,将患者分为认知功能障碍组与非认知功能障碍组,比较两组患者的临床特征、心脏移植围术期特征、住院期间结局和供者特征。排除数据缺失者(n=34)后,最终认知功能障碍组和非认知功能障碍组分别有48例和50例患者纳入分析。采用单因素和多因素Logistic回归分析评估心脏移植术后中期单次测评诊断的认知功能障碍的潜在影响因素。结果:纳入患者心脏移植手术与术后认知测评的中位时间间隔为2(1,4)年。心脏移植术后中期单次测评诊断的认知功能障碍发生率为50.0%(66/132)。与非认知功能障碍组相比,认知功能障碍组患者心脏移植手术时年龄[(40.2±13.4)岁vs(.46.4±11.0)岁]和认知测评时年龄[(42.3±13.0)岁vs(.49.2±11.2)岁]均更大,男性比例更高(68.0%vs.87.5%),教育程度较低(高中以下)者比例更高(31.9%vs.63.8%),术后住院时间更长[32.0(26.0,38.8)d vs.38.0(20.3,50.0)d],组间差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,认知测评时年龄越大(OR=1.067,95%CI:1.019~1.117,P=0.005),心脏移植术后住院时间越长(OR=1.051,95%CI:1.006~1.097,P=0.025),心脏移植术后中期单次测评诊断认知功能障碍的风险越高,而高中以上教育程度(OR=0.132,95%CI:0.029~0.607,P=0.009)则是心脏移植术后中期单次测评诊断认知功能障碍的独立保护因素。结论:心脏移植术后中期单次测评诊断的认知功能障碍发生率较高。对�Objectives:To investigate the incidence and related risk factors of mid-term postoperative cognitive impairment by a single cognitive function test among heart transplant recipients.Methods:The heart transplant recipients who visited our heart transplant outpatient department from May to October of 2019 were recruited and received cognitive function test.Their heart transplantation,anesthesia,cardiopulmonary bypass and immunosuppressive therapy were performed by the same heart transplant team.Mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)were used to test the study population and diagnose cognitive impairment.The patients were divided into cognitive impairment group and non-cognitive impairment group,and the clinical characteristics,perioperative characteristics of heart transplantation,hospital outcomes and donor characteristics were compared between the two groups.After excluding those with missing data(n=34),48 patients in the cognitive impairment group and 50 patients in the non-cognitive impairment group were analyzed.Univariate and multivariate logistic regression were used to analyze the potential influencing factors of cognitive impairment diagnosed by a single assessment after heart transplantation.Results:The median time of cognitive test after surgery was 2(1,4)years.The incidence of mid-term postoperative cognitive impairment by a single test among heart transplant recipients was 50.0%(66/132).Compared with the non-cognitive impairment group,patients in the cognitive impairment group were older at heart transplant([40.2±13.4]years vs.[46.4±11.0]years)and at cognitive test([42.3±13.0]years vs.[49.2±11.2]years),with a higher proportion of males(68.0%vs.87.5%),a higher proportion of those with lower education(less than high school)(31.9%vs.63.8%),and a longer postoperative hospital stay(32.0[26.0,38.8]d vs.38.0[20.3,50.0]d),and the differences between groups were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that older age at cognit

关 键 词：心脏移植 术后认知功能障碍 发生率 相关因素 

分 类 号：R54[医药卫生—心血管疾病]