【摘要】 目的 了解心臟瓣膜置換術后認知功能障礙（POCD）的危險因素，明確圍手術期腦糖代謝異常是否為術后POCD的可能發病機制之一。 方法 選取2004年3月-2009年7月心臟瓣膜置換術患者70例，根據術后第7天患者認知功能測定結果分為POCD組（n =31）和非POCD組（n =39），比較兩組患者年齡、性別、體外循環（CPB）時間、主動脈阻斷時間、主動脈阻斷后平均動脈壓和平均灌注流量，并且分別于麻醉后手術前（T1）、CPB穩定的低溫期（T2）、復溫至33℃（T3）、CPB結束后30 min（T4）4個時點采動脈及頸內靜脈血，測定血氣、血糖濃度，計算出腦攝氧率（CEO2）、腦糖攝取Glu（a-v）。 結果 發生POCD的患者年齡較非POCD組大，并且CPB時間和主動脈阻斷時間也更長，兩組之間比較有統計學差異（P lt;0.05），但是兩組在性別、主動脈阻斷后平均動脈壓和平均灌注流量比較無統計學差異。兩組的CEO2變化趨勢一致，各時點的值無明顯變化，兩組間比較無差異；非POCD組的Glu（a-v）各時點間比較無統計學差異，POCD組的Glu（a-v）T1、T2時點也無明顯變化，但POCD組的Glu（a-v）在T3、T4明顯降低，并且與非POCD組比較有統計學意義（P lt;0.05）。 結論 年齡、CPB時間和主動脈阻斷時間是POCD發生的危險因素。腦糖代謝異常是POCD發生的可能機制之一。
【Abstract】 Objective To understand the risk factor of postoperative cognitive dysfunction (POCD), and identify whether perioperative brain glucose metabolism disorder was or not pathogenesis of POCD after heart valve replacement operation. Methods From March 2004 to July 2009, 70 patients with heart valve replacement were divided into POCD group (n=31) and non-POCD group (n=39) according to cognitive function status tested on the seventh day after operation. The age, sex, cardiopulmonary bypass (CPB) duration, aortic crossclamp duration, mean arterial blood pressure and mean priming volume after aortic crossclamp of two groups were compared. Blood samples were drawn from the radial artery and jugular bulb catheters for determination of blood gas and glucose after induction of anaesthesia (baseline), at the time of the lowest CPB temperature, rewarming to 33℃, and 30 minutes after termination of CPB, CEO2 and Glu (a-v) were calculated: CEO2= (CaO2－CvO2) /CaO2. Results In POCD group, the average age was larger and CPB duration and aortic crossclamp duration was longer than in non-POCD group (P lt;0.05) , but there were no statistical differences in sex, mean arterial blood pressure and mean priming volume after aortic crossclamp. The change tendency of CEO2 of two groups were similar and without significant difference. Glu (a-v) of non-POCD group had no difference in every point, and Glu (a-v) of POCD group had no difference in T1 and T2 points, but value of Glu (a-v) of POCD group decreased obviously and had distinct difference with that of non-POCD group in T3 and T4 points (P lt;0.05). Conclusion Age, CPB duration, and aortic crossclamp duration were risk factors of POCD. Brain glucose metabolism disorder was possibly one of pathogenesis of POCD.
引用本文： 肖宗位,馬建陽,郭應強,張爾永. 心臟瓣膜置換術圍手術期腦糖代謝異常與術后認知功能障礙相關性研究. 華西醫學, 2010, 25(7): 1273-1275. doi: 復制