腺苷预处理对瓣膜置换术后老年患者早期认知功能障碍的影响

摘要

目的 观察腺苷预处理对老年患者瓣膜置换术后早期认知功能障碍(PDCD)的影响.方法 选择拟行瓣膜置换手术、年龄大于或等于60岁的老年患者60例,分为腺苷组和对照组,每组30例.腺苷组于体外循环停搏液中加入腺苷2 mmol/L.使用简易智力量表(MMSE)、数字广度测验(DSpT)、数字符号测验(DSyT)、循迹连线测验(TMT)和小故事记忆测试(SMT)等5项量表,分别于术前、术后7 d及术后2 周对患者进行神经心理学测试,术后有2个或2个以上的测验项目出现功能恶化认为该患者发生了POCD.结果 60例患者完成了术后7 d的神经心理学测试,对照组和腺苷组的POCD发生率分别为40.0%和23.0%,腺苷组明显低于对照组(P<0.05);术后2 周完成测试患者57例,对照组29例,腺苷组28例.两组POCD发生率分别为8例(27.6%)和6例(21.4%),差异无统计学意义(P>0.05).结论 腺苷预处理可降低术后7 d时体外循环下瓣膜置换术后老年患者POCD的发生率.%Objective To investigate effects of adenosine on early postoperative cognitive dysfunction(POCD) in elderly patients undergoing cardiac valve replacement surgery. Methods Sixty patients older than 60 years of age, scheduled for selective cardiac operation were selected for this study. Patients were randomly divided into two groups:control and adenosine groups. Adenosine disodium triphosphate(2 mmol/L)was added into heart arresting solution in adenosine group. Neuropsychological testing was performed with neurocognitive test battery consists of MMSE,DSpT,DSyT, TMT and SMT at pre-operation,7 days and 2 weeks after surgery. Results 57 patients completed all tests. POCD was present in 12 (40.0 ％)patients in control group, 7 (23.3 ％) patients in adenosine group at 7 days after surgery. The incidence of POCD in adenosine group at 7 days after surgery was lower than that in control group(P＜0.05). However,the incidence of POCD was not different at 2 weeks after surgery. Conclusion Adenosine could reduce the incidence of POCD in elderly patients undergoing cardiac valve replacement surgery within 7 days.