DUAN Zhenxin,CHEN Fang,ZHONG Hejiang,et al.Effect of postoperative cognitive dysfunction on rehabilitation of patients after cardiac valve replacement surgery [J].J Third Mil Med Univ,2019,41(11):1077-1082.

术后认知功能障碍对心脏瓣膜置换手术患者康复的影响(/HTML )




Effect of postoperative cognitive dysfunction on rehabilitation of patients after cardiac valve replacement surgery
DUAN Zhenxin CHEN Fang ZHONG Hejiang DUAN Guangyou WANG Yang LU Peng JIANG Xuetao DU Zhiyong LI Hong  

Department of Anesthesiology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China

postoperative cognitive dysfunction heart valve replacement surgery rehabilitation
R493; R654.2; R741

目的 探讨心脏瓣膜置换手术患者术后认知功能障碍(postoperative cognitive dysfunction, POCD)对康复情况的影响。方法 从前期收集心脏瓣膜置换手术患者的前瞻性研究数据中,纳入2016年10月至2018年6月本院心脏外科拟行心脏瓣膜置换手术的252例住院患者[男性104例,女性148例,年龄(47.1±8.8)岁]进行回顾性分析。在术前1 d和术后第7天采用神经心理测试对患者进行认知功能评估,然后根据评估结果将患者分为POCD组(P组)和非POCD组(N组)。通过非条件Logistic回归筛选出POCD的危险因素(年龄和麻醉方式),然后将其设为协变量进行1∶1倾向性评分匹配,得到100例患者[男性39例,女性61例,年龄(48.5±9.6)岁]。比较匹配后P组(n=50)和N组(n=50)患者的术后住院时间、术后并发症发生率、活动情况、心脏功能指标等术后康复情况。 结果 ①P组患者的ICU住院时间[P组(3.9±1.6)d, N组(3.3±0.7)d,P=0.012]和总住院时间[P组(23.1±7.3)d,N组(19.5±4.1)d,P=0.003]均长于N组患者。②P组患者术后第7天的Katz Index活动评分低于N组患者[P组(2.9±1.1),N组(3.4±0.8),P=0.025]。③术后两组心脏功能各项指标差异无统计学意义。结论 POCD会明显延缓心脏瓣膜置换手术患者的术后康复时间,降低患者术后活动能力,但对患者术后心功能的康复情况并无影响。


Objective To determine the effect of postoperative cognitive dysfunction (POCD) on postoperative rehabilitation of the patients undergoing heart valve replacement. Methods A total of 252 patients (104 males and 148 females, at an age of 47.1±8.8) who were prospectively scheduled for cardiac valve replacement surgery in our hospital from October 2016 to June 2018 were enrolled, and their clinical data were collected and retrospectively analyzed. The cognitive function of the patients was assessed by neuropsychological tests at 1 d before and 7 d after operation. Cognitive function assessment was carried out in 1 d before and in 7 d after surgery. According to the results, the patients were divided into POCD group (group P) and non-POCD group (group N). Unconditional logistic regression analysis was performed to screen the risk factors for POCD. With age and anesthesia as covariates, the 252 patients were played to 1∶1 propensity score matching to obtain 100 patients (39 male and 61 female patients, 48.5±9.6 years old), and the postoperative hospital stay, postoperative complications, activity conditions, and cardiac function were analyzed between the 2 groups (n=50). Results ①The patients of group P had significantly longer lengths of ICU stay (3.9±1.6 vs 3.3±0.7 d, P=0.012) and of hospital stay (23.1±7.3 vs 19.5±4.1 d, P=0.003) than those of the group N. ② The Katz Index activity score on the 7th day after surgery was obviously lower in the group P than the group N (2.9±1.1 vs 3.4±0.8, P=0.025). ③ There was no significant difference in cardiac function between the 2 groups after operation.  Conclusion POCD significantly delays postoperative rehabilitation time and reduces postoperative activity in the patients undergoing heart valve replacement surgery, but it has no effect on postoperative cardiac function.


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更新日期/Last Update: 2019-06-06