目的：研究颈动脉疾患与非体外循环冠脉旁路移植术（OPCABG）后患者认知障碍（POCD）的关系。方法对心外科择期行OPCABG的157例患者按术后5 d采用中文版简易智能状态检查（MMSE）问卷成绩分为POCD组48例和无POCD组109例。对比2组年龄、性别、文化水平、高血压病史、糖尿病史、脑卒中史等多个传统危险因素，对其中有统计学意义的指标进行多因素logistic回归分析。在手术前1 d和手术后7 d，应用洛文斯顿认知功能成套测验（LOTCA）对患者认知功能进行评分，根据得分结果评估颈动脉狭窄对POCD的可能影响。结果157例患者中48例患者有认知障碍，发生率为30.6%。2组年龄、糖尿病史、文化水平、颈动脉狭窄程度、术后血红蛋白、术前LOTCA成套检测评分、呼吸机辅助时长、监护室停留时长差异有统计学意义。logistic回归显示：年龄大、颈动脉狭窄程度重和监护室停留时间长是认知障碍的危险因素，并且尤以颈动脉狭窄程度的影响最为显著（OR=5.078，95%CI：2.211~11.662，P<0.001）。颈动脉狭窄程度严重的患者在定向、动作运用、视运动组织、思维操作、注意力及专注力方面得分明显下降。结论颈动脉狭窄是OPCABG后POCD的最重要的危险因素。%Objective To analyze the correlation of carotid artery stenosis(CAS)with postoperative cognitive dysfunc⁃tion(POCD)in patients who underwent off-pump coronary artery bypass grafting(OPCABG). Methods Between March 2014 and October 2014, a total of 157 patients who underwent OPCABG in our hospital were enrolled and divided into POCD group and non-POCD group according to their performance respondent to MMSE questionnaire survey conducted 5 days before operation. LOTCA questionnaire survey was conducted at the first day and 7th days pre-and post-operation re⁃spectively in order to investigate the influence of CAS on POCD in patients. Results The incidence of POCD was 30.6%(48 out of 157). Advanced age, diabetes,cultural level,carotid artery stenosis, Hb level after operation, score of LOTCA question⁃naire survey conducted before surgery,time of respirator and the time spend in ICU were significant predictive factors for POCD. However, multivariate logistic regression analysis showed that age, CAS and the time spend in ICU were independent risk factors for POCD, especially CAS(OR=5.078,95%CI:2.211-11.662, P<0.001). Patients with severe CAS suffer from a significant decline in cognitive function on space, time, action and ideation. Conclusion CAS is a predominant risk factor for POCD in patients undergoing OPCABG.
展开▼
