国际麻醉学与复苏杂志   2018, Issue (12): 0-0
    
稀释性贫血对体外循环术后患者认知功能的影响
郑蒙蒙, 齐敦益, 曹媛媛, 谭薇, 张文文, 彭洁1()
1.徐州医科大学附属医院
Effect of emodilutional anemia on postoperative cognitive function in patients undergoing cardiopulmonary bypass
 全文:
摘要:

目的 评价CPB期间Hb浓度对患者术后认知功能障碍(postoperative cognitive dysfunction, POCD)的影响。 方法 选取择期进行CPB手术的患者108例,根据患者CPB期间Hb的浓度分为正常组(Ⅰ组,Hb>110 g/L,15例)、轻度贫血组(Ⅱ组,Hb 90~110 g/L,45例)和中度贫血组(Ⅲ组,Hb 60~90 g/L,48例)。记录患者术前1 d、完全心肺转流术开始后、术后第1天、术后第2天、术后第3天、术后第4天、术后第7天的Hb浓度,以及CPB开始、CPB期间和CPB结束时的脑氧饱和度(cerebral oxygen saturation, rSO2)数值。 采用国际POCD研究组(international study of postoperative cognitive dysfunction, ISPOCD)公认的神经心理学测试方法记录患者术前l d和术后第7天的认知评估数值。分析3组患者Hb浓度、rSO2和术后认知功能之间的关系。 结果 3组患者基础情况和术中信息差异无统计学意义(P>0.05)。3组患者术前1 d的神经心理学测试总分之间差异无统计学意义(P>0.05)。与Ⅰ组比较,Ⅱ组患者术后第7天的神经心理学测试评分差异无统计学意义(P>0.05),Ⅲ组患者术后第7天的神经心理学测试评分明显降低(P<0.05)。与Ⅰ组比较,Ⅱ组和Ⅲ组患者术后第7天POCD发生率升高,且Ⅲ组高于Ⅱ组(P<0.05)。与Ⅰ组比较,Ⅱ组和Ⅲ组的rSO2平均值和rSO2最小值明显降低(P<0.05)。单变量回归分析发现rSO2最小值和Hb浓度是POCD的独立危险因素,运用多变量回归分析进一步筛查,发现仅Hb浓度是POCD的独立危险因素。结论 贫血患者较易发生术后早期POCD,可能与术中rSO2下降有关。Hb浓度可能是POCD的独立危险因素。

关键词: 脑氧饱和度; 血红蛋白; 贫血; 术后认知功能障碍
Abstract:

Objective To evaluate the effects of hemoglobin(Hb) concentrations during cardiopulmonary bypass (CPB) on postoperative cognitive dysfunction (POCD) in patients. Methods One hundred and eight patients underwent cardiopulmonary bypass were enrolled in this study. According to their Hb concentrations, patients were divided into 3 groups. Patients with normal levels of Hb, 90-110, 60-90 g/L Hb were respectively assigned into groupⅠ, group Ⅱ and group Ⅲ. The patients′ Hb concentration 1 day before the surgery, during cardiopulmonary bypass, 1, 2, 3, 4 and 7 days after the surgery were measured. The cerebral oxygen saturation (rSO2) was also assayed during CPB. The score of the neuropsychological test on the day before surgery and the seventh day after surgery were recorded. Whether Hb concentration and rSO2 levels affect the incidence of postoperative cognitive function was analyzed. Results Among three groups, no significant difference was found in basic and operative information, and the score of the neuropsychological test on one day before surgery(P>0.05). The neuropsychological scores at the seventh day after surgery were lower in group Ⅲ compared with groupⅠ(P<0.05). The incidence of POCD was higher in group Ⅱ and group Ⅲ than that in groupⅠ(P<0.05). Compared with groupⅠ, the rSO2 mean and rSO2 min were lower in group Ⅱ and Ⅲ on the seventh day after surgery(P<0.05). Conclusions Patients with anemia are susceptible to POCD, which might be related to decreased cerebral oxygen saturation. Hb concentration may be an independent risk factor for POCD.

Key words: Cerebral oxygen saturation; Hemoglobin; Anemia; Postoperative cognitive dysfunction