摘要
目的：观察中国人冠状动脉旁路移植手术后谵妄与认知功能障碍的关系。方法：接受择期冠状动脉旁路移植手术的107例患者,记录术前基础指标、围术期相关指标及术后并发症发生情况。术后第17天采用CAM-ICU法（Confusion Assessment Method-Intensive Care Unit）每天2次评估是否发生谵妄;分别在术前1天和术后第7天进行9项认知功能测验,术后认知功能障碍的诊断采用与ISPOCD1研究同样的标准。结果：术后谵妄的发生率为47.7%（51/107）,术后认知功能障碍的发生率为55.3%（57/103）。多因素Logistic回归分析显示术后谵妄的独立危险因素有年龄增加（OR1.174,95%CI1.0851.269,P〈0.001）、术前糖尿病史（OR4.224,95%CI1.54311.563,P=0.005）、术后发生并发症（OR3.667,95%CI1.15211.670,P=0.028）和术后监护室停留时间长（OR1.024,95%CI1.0051.044,P=0.016）;术后认知功能障碍的独立危险因素有年龄增加（OR1.065,95%CI1.0011.134,P=0.047）和术后谵妄持续时间长（OR1.744,95%CI1.1732.593,P=0.006）。结论：谵妄和认知功能障碍是中国人冠状动脉旁路移植手术后早期常见的并发症,术后谵妄持续时间长是术后认知功能障碍的独立危险因素。
Objective：To investigate the relationship between postoperative delirium（POD） and postoperative cognitive dysfunction（POCD） after coronary artery bypass graft in Chinese population.Methods： One hundred and seven patients who were referred for elective coronary artery bypass grafting（CABG） surgery were enrolled in this prospective cohort study.Baseline and perioperative variables as well as occurrence of postoperative complications were recorded.POD was diagnosed using the Confusion Assessment Method for the Intensive Care Unit twice daily during the first seven postoperative days.A neuropsychological test battery that included 7 tests with 9 subscales was administered at baseline and on the seventh day after surgery.POCD was defined using the same definition that was used in the ISPOCD1 study.Results： The incidence of POD was 47.7%（51/107） while that of POCD was 55.3%（57/103）.Multivariate Logistic regression analyses identified four independent risk factors of POD,i.e.,increasing age（OR 1.174,95% CI 1.085-1.269,P〈0.001）,preoperative history of diabetes mellitus（OR 4.224,95% CI 1.543-11.563,P=0.005）,occurrence of postoperative complications（OR 3.667,95% CI 1.152-11.670,P=0.028）,and prolonged duration of intensive care unit stay（OR 1.024,95% CI 1.005-1.044,P=0.016）.And two independent risk factors of POCD were identified,i.e.,increasing age（OR 1.065,95% CI 1.001-1.134,P=0.047） and prolonged duration of POD（OR 1.744,95% CI 1.173-2.593,P=0.006）.Conclusion： POD and POCD are common cognitive complications after CABG surgery in Chinese population.Prolonged duration of POD is an independent risk factor of the occurrence of POCD.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2011年第2期242-249,共8页
Journal of Peking University:Health Sciences
关键词
冠状动脉分流术
谵妄
认知障碍
手术后并发症
危险因素
Coronary artery bypass grafting； Delirium； Cognition disorders； Postoperative complications； Risk factors
