Ge Yali, Ma Zhengliang, Shi Hongwei, Zhao Yamei, Gu Xiaoping, Wei Haiyan
Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006,China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2014 Oct;39(10):1049-55. doi: 10.11817/j.issn.1672-7347.2014.10.011.
To investigate the incidence rate and the risk factors for postoperative cognitive dysfunction (POCD) in patients underwent coronary artery bypass grafting surgery.
A total of 147 patients underwent elective coronary artery bypass grafting (CABG) surgery between January to July 2013 were included in this study. POCD was diagnosed using a neuropsychological test battery. All enrolled patients were interviewed on the day before surgery, the seventh day and 3 months after surgery, respectively, by the same researcher, and were divided into two groups based on the results: the POCD group and the non-POCD group. The information, including age, sex, body mass index, educational status, comorbidities, history of smoking and drinking, ASA grade, left ventricular ejection fraction, operation method, duration of operations, regional cerebral oxygen saturation, the lowest haemoglobin concentrations and the haemoglobin concentration decline rate during the operation, tracheal catheter retention time, postoperative pain on visual analogue scales (VAS) and systemic inflammatory response syndrome score (SIRS score), were recorded based on a schedule of survey. Multivariate logistic regression was used to analyze the risk factors for POCD.
A total of 101 patients finished this study. On 7 days and 3 months after surgery, 38 and 21 cases showed POCD, with an incidence rate at 37.6% and 20.8%, respectively. Interestingly, there was no significant difference in incidence of POCD between CABG and OPCABG group on both 7 days and 3 months after surgery (P>0.05). The logistic stepwise regression analysis indicated that the risk factors for POCD included advanced age (OR=1.177, 95%CI 1.071-1.292, P=0.001), the haemoglobin concentration decline rate (OR=1.334, 95%CI 1.152-1.545, P<0.05) and SIRS score (OR=2.815, 95%CI 1.014-7.818, P=0.047).
The incidence rate of POCD was 37.6% and 20.8% on 7 days and 3 months after surgery respectively. Advanced age, the haemoglobin concentration decline rate and SIRS score are independent risk factors for POCD in patients underwent coronary artery bypass grafting surgery.
探讨冠状动脉搭桥手术患者术后认知功能障碍（POCD）的发生率及危险因素。
本研究纳入了2013年1月至7月期间共147例行择期冠状动脉搭桥（CABG）手术的患者。采用一套神经心理测试来诊断POCD。所有纳入的患者在手术前一天、术后第7天和术后3个月分别由同一名研究人员进行访谈，并根据结果分为两组：POCD组和非POCD组。根据调查时间表记录相关信息，包括年龄、性别、体重指数、教育程度、合并症、吸烟和饮酒史、美国麻醉医师协会（ASA）分级、左心室射血分数、手术方式、手术时长、局部脑氧饱和度、术中最低血红蛋白浓度及血红蛋白浓度下降率、气管导管留置时间、术后视觉模拟评分法（VAS）疼痛评分及全身炎症反应综合征评分（SIRS评分）。采用多因素逻辑回归分析POCD的危险因素。
共有101例患者完成本研究。术后7天和3个月时，分别有38例和21例出现POCD，发生率分别为37.6%和20.8%。有趣的是，术后7天和3个月时，CABG组和非体外循环冠状动脉搭桥术（OPCABG）组的POCD发生率无显著差异（P>0.05）。逻辑逐步回归分析表明，POCD的危险因素包括高龄（OR=1.177，95%CI 1.071 - 1.292，P=0.001）、血红蛋白浓度下降率（OR=1.334，95%CI 1.152 - 1.545，P<0.05）和SIRS评分（OR=2.815，95%CI 1.014 - 7.818，P=0.047）。
术后7天和3个月时POCD的发生率分别为37.6%和20.8%。高龄、血红蛋白浓度下降率和SIRS评分是冠状动脉搭桥手术患者发生POCD的独立危险因素。
