本文選題：心臟瓣膜術(shù) + 認(rèn)知功能障礙　； 參考：《醫(yī)學(xué)研究生學(xué)報(bào)》2017年05期

【摘要】：目的術(shù)后認(rèn)知功能障礙(POCD)是心臟手術(shù)常見(jiàn)的并發(fā)癥,嚴(yán)重影響患者的預(yù)后。文中旨在探討心臟瓣膜手術(shù)早期POCD的相關(guān)危險(xiǎn)因素及早期POCD與血清S100B蛋白水平的相關(guān)性。方法選取2015年6月到2016年8月南昌大學(xué)第一附屬醫(yī)院心胸外科行二尖瓣置換聯(lián)合三尖瓣直視成形手術(shù)的80例患者,分別于術(shù)前第1天、術(shù)后第5天對(duì)入選患者進(jìn)行神經(jīng)功能評(píng)定,按患者是否發(fā)生POCD分為POCD組和非POCD組。記錄2組患者年齡、性別、教育程度、New Euroscore II評(píng)分、本次入院術(shù)前NYHA心功能分級(jí)及左室射血分?jǐn)?shù)等指標(biāo)。分別于手術(shù)當(dāng)天早上8點(diǎn)、體外循環(huán)結(jié)束后30 min、24 h、48 h、72 h采集患者靜脈血,采用ELISA法測(cè)定S100B蛋白水平。采用單因素分析及l(fā)ogistic回歸分析早期POCD的危險(xiǎn)因素。結(jié)果 POCD組患者20例,非POCD組患者60例。高血糖[OR=6.038,95%CI:1.202~30.337]、手術(shù)時(shí)間[OR=6.423,95%CI:1.276~32.332]、AST值大于正常值2倍[OR=12.878,95%CI:2.289~72.445]是早期POCD的獨(dú)立危險(xiǎn)因素。與POCD組體外循環(huán)結(jié)束后30 min、24 h的S100B蛋白濃度[(2.4±0.4)、(2.1±0.3)μg/L]比較,POCD組體外循環(huán)結(jié)束后72 h明顯降低[(1.7±0.4)μg/L];與非POCD組體外循環(huán)結(jié)束后48 h S100B蛋白濃度[(1.5±0.4)μg/L]比較,非POCD組體外循環(huán)結(jié)束后72 h[(1.4±0.4)μg/L]明顯降低(P0.05)。結(jié)論手術(shù)時(shí)間長(zhǎng),圍術(shù)期高血糖、AST值大于正常值2倍可預(yù)示早期POCD的發(fā)生;血清S100B蛋白可作為早期POCD的重要標(biāo)志物。
[Abstract]:Objective postoperative cognitive impairment (POCD) is a common complication of cardiac surgery, which seriously affects the prognosis of patients. The aim of this study was to investigate the risk factors associated with early POCD and the correlation between early POCD and serum S100B protein level in heart valve surgery. Methods from June 2015 to August 2016, 80 patients underwent mitral valve replacement combined with tricuspid valve plasty in cardiothoracic surgery, first affiliated Hospital of Nanchang University. Neurological function was assessed on the 5th day after operation. POCD was divided into POCD group and non-POCD group according to whether POCD occurred or not. The scores of age, sex, education level, NYHA cardiac function and left ventricular ejection fraction (LVEF) were recorded. Venous blood was collected at 8 o'clock on the day of operation and 30 min after CPB for 48 h and 72 h after CPB. The level of S100B protein was determined by Elisa. Univariate analysis and logistic regression analysis were used to analyze the risk factors of early POCD. Results there were 20 cases in POCD group and 60 cases in non-POCD group. Hyperglycemia [ORO 6.038 / 95 CI: 1.2022], operative time [OR6.42395 CI: 1.276C: 32.332] AST was 2 times higher than normal [OR12.87895 CI: 2.289 + 72.445] was an independent risk factor for early POCD. The S100B protein concentration in POCD group was significantly lower than that in POCD group at 24 hours after CPB [(2.4 鹵0.4), (2.1 鹵0.3) 渭 g / L] at 72 h after CPB [(1.7 鹵0.4) 渭 g / L], and significantly decreased in non-POCD group at 72 h [(1.4 鹵0.4) 渭 g / L] compared with that in non-POCD group at 48 h after cardiopulmonary bypass [(1.5 鹵0.4) 渭 g / L]. Conclusion the time of operation is long, the AST value of hyperglycemia in perioperative period is 2 times higher than the normal value, and the serum S100B protein can be used as an important marker of early POCD.
【作者單位】： 南昌大學(xué)第一附屬醫(yī)院麻醉科;南昌大學(xué)醫(yī)學(xué)院研究生學(xué)院;
【基金】：江西省科學(xué)技術(shù)廳社會(huì)發(fā)展基金(2009BSB11217)
【分類號(hào)】：R654.2

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本文編號(hào)：2076773