急性A型主动脉夹层术后认知功能障碍危险因素分析

摘要

目的 探讨急性A型主动脉夹层患者术后认知功能障碍(POCD)的危险因素.方法 选取2011年8月至2014年7月首都医科大学附属北京安贞医院大血管疾病诊疗中心收治的168例行深低温停循环选择性脑灌注手术的急性A型主动脉夹层患者,术前收集患者一般资料及既往史.术前和术后14d使用简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估患者神经系统和认知功能,判断是否出现POCD,并以此将患者分为POCD组(56例)与非POCD组(112例),分析POCD的危险因素.结果 POCD总发生率为33.3％ (56/168).POCD组既往脑梗死、高血压比例明显高于对照组[60.7％(34/56)比35.7％(40/112),92.9％(52/56)比89.3％(100/112)],差异有统计学意义(P＜0.05).POCD组在视空间与执行、命名能力、注意能力、语言能力、抽象能力、延迟记忆能力、定向力7个认知域的得分均明显低于非POCD组[(2.78±1.52)分比(4.45±0.71)分,(2.51±0.24)分比(2.96±0.43)分,(3.97±1.69)分比(5.86±0.51)分,(1.78±0.29)分比(2.46±0.63)分,(0.95±0.87)分比(1.95±0.93)分,(1.79±1.22)分比(4.12±0.14)分,(5.19±0.24)分比(5.92±0.17)分],差异有统计学意义(P＜0.05).结论 既往脑梗死、高血压是发生POCD的危险因素.%Objective To investigate the risk factors of postoperative cognitive dysfunction (POCD) in patients of acute type A aortic dissection.Methods One hundred and sixty-eight patients of acute type A aortic dissection who underwent selective antegrade cerebral perfusion under deep hypothermic circulatory arrest from August 2011 to July 2014 were collected.The general data and past history of the patients were recorded before operation.Before and 14 days after operation,the nervous and cognitive function were assessed using minimum mental state examination (MMSE) and Montreal cognitive assessment (MoCA) to diagnose POCD,and then the patients were divided into POCD group (56 cases) and non-POCD group (112 cases).The risk factors of POCD were analyzed.Results The total incidence of POCD was 33.3％ (56/168).The rates of previous cerebrovascular disease history and hypertension in POCD group were significant higher than those in non-POCD group [60.7％ (34/ 56) vs 35.7％ (40/112),92.9％ (52/56) vs 89.3％ (100/112),P ＜ 0.05].The scores of cognitive function including the visual space and execution,depending on-named ability,attention,language ability,abstract ability,delayed memory ability and directional power ability in POCD group were significantly lower than those in nonPOCD group [(2.78 ± 1.52) scores vs (4.45 ± 0.71) scores,(2.51 ± 0.24) scores vs (2.96 ± 0.43) scores,(3.97 ± 1.69) scores vs (5.86 ± 0.51) scores,(1.78 ± 0.29) scores vs (2.46 ± 0.63) scores,(0.95 ± 0.87) scores vs (1.95 ±0.93) scores,(1.79 ± 1.22) scores vs (4.12 ±0.14) scores,(5.19 ±0.24) scores vs (5.92 ±0.17) scores] (P ＜0.05).Conclusion Previous cerebrovascular disease history and hypertension are independent risk factors of POCD in patients of acute type A aortic dissection after surgery.