Department of Cardiovascular Surgery, Adiyaman Training and Research Hospital, Adiyaman, Turkey.
Department of Neurology, Adiyaman Training and Research Hospital, Adiyaman, Turkey.
Ideggyogy Sz. 2022 Jul 30;75(7-08):231-240. doi: 10.18071/isz.75.0231.
Postoperative cognitive dysfunction (POCD) is a multifactorial image characterized by insufficiency in features such as the ability to perform tasks requiring high brain functions. Cognitive dysfunction such as memory loss and decreased concentration, confusion, and delirium are common conditions in some patients in the early period after major surgical interventions such as cardiac surgery. POCD causes delays in postoperative recovery, long return-to-work times, and decreased quality of life. This study aims to demonstrate POCD in early and late stages in patients undergoing cardiac surgery through the Montreal Cognitive Assessment (MoCA) and the Mini Mental Test (MMT). In addition, we aim to determine predictive factors with these neurocognitive tests.
MMT and MoCA tests were applied to the patients included in the study before cardiac surgery, on the sixth postoperative day and third month. Neuro-cognitive dysfunction detected on the sixth postoperative day was accepted as an early period, its detection in the postoperative third month was accepted as a late period.
127 patients without neurocognitive dysfunction in the preoperative period were included in the study. For early neurocognitive impairment, age, mean platelet volume (MPV), New York Heart Association (NYHA) classification, x-clamp time, cardio-pulmonary bypass (CPB) time, postoperative intensive care and hospital stay duration, and an event of acute myocardial infarction (AMI) in the preoperative period were determined as predictive factors. In addition, in late-period of neurocognitive dysfunction age, MPV, NYHA classification, x-clamp duration, CPB time, postoperative intensive care and hospital stay duration were shown as predictors of neurocognitive dysfunction.
The results of our study support the literature findings showing that delirium is associated with a decline in cognitive functions three months after cardiac surgery. As a result, the lack of agreed diagnostic tests in the definition of POCD makes it difficult to standardize and interpret the research in this area. Therefore, a consensus to be reached in the diagnosis of POCD will ensure the use and correct interpretation of neurophysiological tests. In our study, advanced age and long hospital and intensive care stays were shown as predictive factors for both early and late neurocognitive dysfunctions. Furthermore, smoking was shown as a predictive factor only for late neurocognitive dysfunction.
术后认知功能障碍（POCD）是一种多因素的影像，其特征是大脑功能要求较高的任务能力不足等特征。认知功能障碍如记忆力减退、注意力下降、意识混乱和谵妄等，是心脏手术后等重大手术干预后早期一些患者的常见症状。POCD 导致术后恢复延迟、重返工作岗位时间延长和生活质量下降。本研究旨在通过蒙特利尔认知评估（MoCA）和简易精神状态检查（MMT）来证明心脏手术后患者的早期和晚期的 POCD。此外，我们旨在通过这些神经认知测试来确定预测因素。
在心脏手术前、术后第 6 天和第 3 个月，对纳入研究的患者进行 MMT 和 MoCA 测试。术后第 6 天检测到的神经认知功能障碍被认为是早期，术后第 3 个月检测到的神经认知功能障碍被认为是晚期。
本研究纳入了 127 例术前无神经认知功能障碍的患者。对于早期神经认知障碍，年龄、血小板平均体积（MPV）、纽约心脏协会（NYHA）分级、x 夹时间、体外循环（CPB）时间、术后重症监护和住院时间以及术前急性心肌梗死（AMI）事件被确定为预测因素。此外，在晚期神经认知功能障碍中，年龄、MPV、NYHA 分级、x 夹时间、CPB 时间、术后重症监护和住院时间均为神经认知功能障碍的预测因素。
我们的研究结果支持文献研究结果，表明心脏手术后 3 个月谵妄与认知功能下降有关。因此，在 POCD 的定义中缺乏一致的诊断测试，使得该领域的研究难以标准化和解释。因此，在 POCD 的诊断中达成共识将确保神经生理测试的使用和正确解释。在我们的研究中，高龄和长住院时间和重症监护时间被证明是早期和晚期神经认知功能障碍的预测因素。此外，吸烟仅被证明是晚期神经认知功能障碍的预测因素。
