心脏瓣膜术后早期认知功能障碍的相关危险因素分析

发布时间：2018-06-28 04:39

本文选题：心脏瓣膜术 + 认知功能障碍　；参考：《医学研究生学报》2017年05期

【摘要】：目的术后认知功能障碍(POCD)是心脏手术常见的并发症,严重影响患者的预后。文中旨在探讨心脏瓣膜手术早期POCD的相关危险因素及早期POCD与血清S100B蛋白水平的相关性。方法选取2015年6月到2016年8月南昌大学第一附属医院心胸外科行二尖瓣置换联合三尖瓣直视成形手术的80例患者,分别于术前第1天、术后第5天对入选患者进行神经功能评定,按患者是否发生POCD分为POCD组和非POCD组。记录2组患者年龄、性别、教育程度、New Euroscore II评分、本次入院术前NYHA心功能分级及左室射血分数等指标。分别于手术当天早上8点、体外循环结束后30 min、24 h、48 h、72 h采集患者静脉血,采用ELISA法测定S100B蛋白水平。采用单因素分析及logistic回归分析早期POCD的危险因素。结果 POCD组患者20例,非POCD组患者60例。高血糖[OR=6.038,95%CI:1.202~30.337]、手术时间[OR=6.423,95%CI:1.276~32.332]、AST值大于正常值2倍[OR=12.878,95%CI:2.289~72.445]是早期POCD的独立危险因素。与POCD组体外循环结束后30 min、24 h的S100B蛋白浓度[(2.4±0.4)、(2.1±0.3)μg/L]比较,POCD组体外循环结束后72 h明显降低[(1.7±0.4)μg/L];与非POCD组体外循环结束后48 h S100B蛋白浓度[(1.5±0.4)μg/L]比较,非POCD组体外循环结束后72 h[(1.4±0.4)μg/L]明显降低(P0.05)。结论手术时间长,围术期高血糖、AST值大于正常值2倍可预示早期POCD的发生;血清S100B蛋白可作为早期POCD的重要标志物。
[Abstract]:Objective postoperative cognitive impairment (POCD) is a common complication of cardiac surgery, which seriously affects the prognosis of patients. The aim of this study was to investigate the risk factors associated with early POCD and the correlation between early POCD and serum S100B protein level in heart valve surgery. Methods from June 2015 to August 2016, 80 patients underwent mitral valve replacement combined with tricuspid valve plasty in cardiothoracic surgery, first affiliated Hospital of Nanchang University. Neurological function was assessed on the 5th day after operation. POCD was divided into POCD group and non-POCD group according to whether POCD occurred or not. The scores of age, sex, education level, NYHA cardiac function and left ventricular ejection fraction (LVEF) were recorded. Venous blood was collected at 8 o'clock on the day of operation and 30 min after CPB for 48 h and 72 h after CPB. The level of S100B protein was determined by Elisa. Univariate analysis and logistic regression analysis were used to analyze the risk factors of early POCD. Results there were 20 cases in POCD group and 60 cases in non-POCD group. Hyperglycemia [ORO 6.038 / 95 CI: 1.2022], operative time [OR6.42395 CI: 1.276C: 32.332] AST was 2 times higher than normal [OR12.87895 CI: 2.289 + 72.445] was an independent risk factor for early POCD. The S100B protein concentration in POCD group was significantly lower than that in POCD group at 24 hours after CPB [(2.4 卤0.4), (2.1 卤0.3) 渭 g / L] at 72 h after CPB [(1.7 卤0.4) 渭 g / L], and significantly decreased in non-POCD group at 72 h [(1.4 卤0.4) 渭 g / L] compared with that in non-POCD group at 48 h after cardiopulmonary bypass [(1.5 卤0.4) 渭 g / L]. Conclusion the time of operation is long, the AST value of hyperglycemia in perioperative period is 2 times higher than the normal value, and the serum S100B protein can be used as an important marker of early POCD.
【作者单位】：南昌大学第一附属医院麻醉科;南昌大学医学院研究生学院;
【基金】：江西省科学技术厅社会发展基金(2009BSB11217)
【分类号】：R654.2

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