冠脉搭桥术后早期认知功能障碍独立危险因素分析
发布时间：2019-01-21 20:57
【摘要】：众所周知，术后认知功能障碍（postoperative cognitive dysfunction,POCD）是手术后常见的并发症之一。POCD广义上是指麻醉和外科手术后，精神心理状态发生改变，表现为学习记忆力、感知力、注意力、抽象思维能力、精神运动速率、执行力、视觉构造能力以及睡眠质量等方面功能障碍，同时伴有社会活动能力减退，即人格、社交能力和技能的改变。在过去的几十年中，大家都致力于对POCD发生机制和病因学的研究，人们提出了诸多假说，并针对一些因素进行验证、讨论，但是，关于POCD更深层次的相关因素与发生机制有待进一步研究。本课题就心脏手术后认知功能障碍的发生率、风险因素以及远期影响做一分析讨论。 本研究主要通过对接受冠脉搭桥手术的患者的临床资料进行整理、统计和分析，总结冠脉搭桥术后发生认知功能障碍的独立危险因素，并加以分析讨论。本项研究课题严格遵循统计学实验设计的基本原则，对自2012年8月至2013年11月，在河北医科大学第二医院心脏大血管外科，接受冠脉搭桥手术的患者进行临床资料的收集，对其术前、术中以及术后相关数据进行统计处理，得到结果并加以分析，最终得出结论。 目的： 中枢神经系统的并发症是心脏手术后常见的并发症之一，它会直接影响到病人心脏手术的预后和生存率。本研究的目的是对冠脉搭桥手术后早期发生认知功能障碍的独立危险因素进行筛选和分析。 方法： 从2012年8月至2013年11月，共102例，其中男性78例，女性24例，，术前合并糖尿病的23例，免疫系统疾病的23例。102例病人中，3例因术后心脏相关并发症死亡，剩余99例病人中93例行不停跳非体外循环冠脉搭桥术（OPCABG）。6例冠心病合并心脏瓣膜病，3例行体外循环冠脉搭桥术（CCABG）+二尖瓣置换术，2例行体外循环冠脉搭桥术+主动脉瓣置换术，1例行体外循环冠脉搭桥术+左房粘液瘤切除术。 术前各项检查均在正常范围内。术前遵医嘱用药将病人的各项指标调整至合适的范围。麻醉术前常规用药，地西泮片0.08~0.15mg/kg术前晚及术日晨口服，酒石酸美托洛尔片12.5~37.5mg术日晨口服，盐酸吗啡注射液0.15~0.2mg/kg术前30分钟肌注，氢溴酸东莨菪碱注射液0.3mg术前30分钟肌注，根据病人具体情况调整用药剂量。麻醉诱导时，静脉注射咪达唑仑0.05~0.1mg/kg，芬太尼5μg/kg，依托咪酯0.2mg/kg，罗库溴铵0.6mg/kg，，术中麻醉维持，微量泵静脉输注丙泊酚2~5mg·kg-1·h-1，瑞芬太尼0.1~0.3ug·kg-1·min-1。行冠脉搭桥术，需要心脏瓣膜置换的病人还需行体外循环辅助。常规进行心电图、脉搏血氧饱和度、有创动脉压、中心静脉压、鼻咽温、呼气末二氧化碳监测、BIS监护。维持呼吸循环稳定。于术前1天、术后3天、7天，分别对患者进行神经心理学评估，采用简易智能量表（MMSE）测试评估。 结果： 术后认知功能障碍的发生率为35.4%。将手术后3天、7天发生认知功能障碍的病人与未发生认知功能障碍的病人的相关数据进行统计分析得出，体外循环（P=0.023），术前合并糖尿病（P0.001），ICU持续输注咪达唑仑（P0.001），BIS值（P=0.042）及术后拔除气管插管时间（P0.001）是术后早期发生认知功能障碍的独立危险因素。 结论： 体外循环，术前合并糖尿病，心外ICU持续泵入咪达唑仑，BIS值和术后拔除气管插管时间是术后早期认知功能障碍发生的独立危险因素。
[Abstract]:It is well known that post-operative cognitive dysfunction (POCD) is one of the most common complications following surgery. The general term of POCD means that after the anesthesia and the surgery, the mental state of mental state changes, which is manifested as the function of learning memory, feeling of understanding, attention, abstract thinking ability, mental movement rate, executive ability, visual construction ability and sleep quality, etc. At the same time, there is a decline in social activities, that is, the change of personality, social skills and skills. In the past few decades, we have been committed to the study of the mechanism and etiology of POCD, and many hypotheses have been put forward, and some factors have been validated and discussed. However, the more profound correlation and mechanism of POCD have to be further studied. This topic discusses the incidence, risk factors and long-term effects of cognitive dysfunction after cardiac surgery. This study is to summarize and analyze the clinical data of patients undergoing coronary artery bypass surgery, and to sum up the independent risk factors of cognitive impairment after coronary artery bypass surgery, and to analyze and discuss them. On the basis of the basic principle of statistical experimental design, the clinical data were collected from August, 2012 to November, 2013 in the second hospital of Hebei Medical University. Before, during and after operation, the relevant data were statistically processed, the results were obtained and analyzed, and finally the junction was obtained. On the other hand. Objective: The complications of the central nervous system are one of the most common complications following cardiac surgery, which can directly affect the pre-operation of the patient's heart. The purpose of this study is to carry out the independent risk factors of cognitive dysfunction in the early stage of coronary artery bypass surgery. Screening and Methods: From August, 2012 to November, 2013, there were 102 cases, including 78 male and 24 female, 23 cases of pre-operative diabetes, 23 cases of immune system disease, and 3 of 102 patients. The heart-related complications were associated with death, and 93 of the remaining 99 patients were non-circulating off-pump coronary artery bypass (OPCABG). 6 cases of coronary heart disease complicated with valvular heart disease, 3 cases of coronary artery bypass grafting (CABG) + mitral valve replacement, 2 cases of extracorporeal circulation coronary artery bypass and aortic valve replacement, 1 case Coronary artery bypass grafting with cardiopulmonary bypass + left atrial myxoma resection. Pre-operative All the examinations are within the normal range. All the patients will be treated with the medication before the procedure. The key parameters were adjusted to the appropriate range. The conventional medication before the operation, 0. 08-0. 15 mg/ kg, oral administration of metoprolol tartrate, 12. 5-37. 5 mg of metoprolol tartrate, 0. 15-0. 2 mg/ kg of morphine hydrochloride, 0. 15-0. 2 mg/ kg, intramuscular injection of 30 minutes before operation, and 0. 3 mg of hydrobromide for the first 30 minutes, according to the disease The dosage of the drug was adjusted in the specific case. In the induction of the anesthesia, the intravenous injection of prochloronil was 0. 05-0. 1 mg/ kg, the fentanyl was 5. m u.g/ kg, the etomidate was 0. 2mg/ kg, the content of the remifentanil was 0. 6mg/ kg, the anesthesia was maintained during the operation, and the intravenous infusion of propofol 2-5mg 路 kg-1 路 h-1 and remifentanil 0.1 ~ 0.32ug in the micropump. 路 kg-1 路 min-1. Coronary artery bypass is required, and heart valve replacement is required. The patient also needs to be assisted by cardiopulmonary bypass. Routine ECG, pulse blood oxygen saturation, invasive arterial pressure, central venous pressure, nasopharyngeal temperature, end of breath 2 Carbon oxide monitoring, BIS The patient underwent neuropsychological assessment on the first day of the operation, 3 days after the operation, and 7 days after the operation, and the simple and intelligent energy was used. Table (M MSE) test evaluation. Results: Post-operative recognition The incidence of cognitive dysfunction was 35. 4%. The data of the patients with cognitive impairment in 3 and 7 days after the operation were statistically analyzed, and the cardiopulmonary bypass (P = 0. 023), the pre-operative combined diabetes (P0.001) and the intensive care unit (ICU) were obtained. The time of reinfusion of Mimidalun (P0.001), BIS (P = 0. 042) and the time of postoperative tracheal intubation (P0.001) was the early postoperative period. to be recognized Conclusion: Extracorporeal circulation, pre-operation and pre-operation combined with diabetes, the continuous pumping of the extracardiac intensive care unit into the prochloronil, the BIS value and the time of the post-operative removal of the tracheal tube is
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：2413033
[Abstract]:It is well known that post-operative cognitive dysfunction (POCD) is one of the most common complications following surgery. The general term of POCD means that after the anesthesia and the surgery, the mental state of mental state changes, which is manifested as the function of learning memory, feeling of understanding, attention, abstract thinking ability, mental movement rate, executive ability, visual construction ability and sleep quality, etc. At the same time, there is a decline in social activities, that is, the change of personality, social skills and skills. In the past few decades, we have been committed to the study of the mechanism and etiology of POCD, and many hypotheses have been put forward, and some factors have been validated and discussed. However, the more profound correlation and mechanism of POCD have to be further studied. This topic discusses the incidence, risk factors and long-term effects of cognitive dysfunction after cardiac surgery. This study is to summarize and analyze the clinical data of patients undergoing coronary artery bypass surgery, and to sum up the independent risk factors of cognitive impairment after coronary artery bypass surgery, and to analyze and discuss them. On the basis of the basic principle of statistical experimental design, the clinical data were collected from August, 2012 to November, 2013 in the second hospital of Hebei Medical University. Before, during and after operation, the relevant data were statistically processed, the results were obtained and analyzed, and finally the junction was obtained. On the other hand. Objective: The complications of the central nervous system are one of the most common complications following cardiac surgery, which can directly affect the pre-operation of the patient's heart. The purpose of this study is to carry out the independent risk factors of cognitive dysfunction in the early stage of coronary artery bypass surgery. Screening and Methods: From August, 2012 to November, 2013, there were 102 cases, including 78 male and 24 female, 23 cases of pre-operative diabetes, 23 cases of immune system disease, and 3 of 102 patients. The heart-related complications were associated with death, and 93 of the remaining 99 patients were non-circulating off-pump coronary artery bypass (OPCABG). 6 cases of coronary heart disease complicated with valvular heart disease, 3 cases of coronary artery bypass grafting (CABG) + mitral valve replacement, 2 cases of extracorporeal circulation coronary artery bypass and aortic valve replacement, 1 case Coronary artery bypass grafting with cardiopulmonary bypass + left atrial myxoma resection. Pre-operative All the examinations are within the normal range. All the patients will be treated with the medication before the procedure. The key parameters were adjusted to the appropriate range. The conventional medication before the operation, 0. 08-0. 15 mg/ kg, oral administration of metoprolol tartrate, 12. 5-37. 5 mg of metoprolol tartrate, 0. 15-0. 2 mg/ kg of morphine hydrochloride, 0. 15-0. 2 mg/ kg, intramuscular injection of 30 minutes before operation, and 0. 3 mg of hydrobromide for the first 30 minutes, according to the disease The dosage of the drug was adjusted in the specific case. In the induction of the anesthesia, the intravenous injection of prochloronil was 0. 05-0. 1 mg/ kg, the fentanyl was 5. m u.g/ kg, the etomidate was 0. 2mg/ kg, the content of the remifentanil was 0. 6mg/ kg, the anesthesia was maintained during the operation, and the intravenous infusion of propofol 2-5mg 路 kg-1 路 h-1 and remifentanil 0.1 ~ 0.32ug in the micropump. 路 kg-1 路 min-1. Coronary artery bypass is required, and heart valve replacement is required. The patient also needs to be assisted by cardiopulmonary bypass. Routine ECG, pulse blood oxygen saturation, invasive arterial pressure, central venous pressure, nasopharyngeal temperature, end of breath 2 Carbon oxide monitoring, BIS The patient underwent neuropsychological assessment on the first day of the operation, 3 days after the operation, and 7 days after the operation, and the simple and intelligent energy was used. Table (M MSE) test evaluation. Results: Post-operative recognition The incidence of cognitive dysfunction was 35. 4%. The data of the patients with cognitive impairment in 3 and 7 days after the operation were statistically analyzed, and the cardiopulmonary bypass (P = 0. 023), the pre-operative combined diabetes (P0.001) and the intensive care unit (ICU) were obtained. The time of reinfusion of Mimidalun (P0.001), BIS (P = 0. 042) and the time of postoperative tracheal intubation (P0.001) was the early postoperative period. to be recognized Conclusion: Extracorporeal circulation, pre-operation and pre-operation combined with diabetes, the continuous pumping of the extracardiac intensive care unit into the prochloronil, the BIS value and the time of the post-operative removal of the tracheal tube is
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
【引证文献】
相关期刊论文 前1条
1 陶香君;丁舒;冯新伟;吴瑛;;心脏术后患者认知功能障碍危险因素的Meta分析[J];中华护理杂志;2016年07期
本文编号：2413033
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