心脏瓣膜置换术围手术期脑糖代谢异常与术后认知功能障碍相关性研究

【】目的了解心脏瓣膜置换术后认知功能障碍（POCD）的危险因素，明确围手术期脑糖代谢异常是否为术后POCD的可能发病机制之一。方法选取2004年3月-2009年7月心脏瓣膜置换术患者70例，根据术后第7天患者认知功能测定结果分为POCD组（n=31）和非POCD组（n=39），比较两组患者年龄、性别、体外循环（CPB）时间、主动脉阻断时间、主动脉阻断后平均动脉压和平均灌注流量，并且分别于麻醉后手术前（T1）、CPB稳定的低温期（T2）、复温至33℃（T3）、CPB结束后30min（T4）4个时点采动脉及颈内静脉血，测定血气、血糖浓度，计算出脑摄氧率（CEO2）、脑糖摄取Glu（a-v）。结果发生POCD的患者年龄较非POCD组大，并且CPB时间和主动脉阻断时间也更长，两组之间比较有统计学差异（P<0.05），但是两组在性别、主动脉阻断后平均动脉压和平均灌注流量比较无统计学差异。两组的CEO2变化趋势一致，各时点的值无明显变化，两组间比较无差异；非POCD组的Glu（a-v）各时点间比较无统计学差异，POCD组的Glu（a-v）T1、T2时点也无明显变化，但POCD组的Glu（a-v）在T3、T4明显降低，并且与非POCD组比较有统计学意义（P<0.05）。结论年龄、CPB时间和主动脉阻断时间是POCD发生的危险因素。脑糖代谢异常是POCD发生的可能机制之一。【Abstract】ObjectiveTounderstandtheriskfactorofpostoperativecognitivedysfunction(POCD),andidentifywhetherperioperativebrainglucosemetabolismdisorderwasornotpathogenesisofPOCDafterheartvalvereplacementoperation.MethodsFromMarch2004toJuly2009,70patientswithheartvalvereplacementweredividedintoPOCDgroup(n=31)andnon-POCDgroup(n=39)accordingtocognitivefunctionstatustestedontheseventhdayafteroperation.Theage,sex,cardiopulmonarybypass(CPB)duration,aorticcrossclampduration,meanarterialbloodpressureandmeanprimingvolumeafteraorticcrossclampoftwogroupswerecompared.Bloodsamplesweredrawnfromtheradialarteryandjugularbulbcathetersfordeterminationofbloodgasandglucoseafterinductionofanaesthesia(baseline),atthetimeofthelowestCPBtemperature,rewarmingto33℃,and30minutesafterterminationofCPB,CEO2andGlu(a-v)werecalculatedCEO2=(CaO2－CvO2)/CaO2.ResultsInPOCDgroup,theaverageagewaslargerandCPBdurationandaorticcrossclampdurationwaslongerthaninnon-POCDgroup(P<0.05),buttherewerenostatisticaldifferencesinsex,meanarterialbloodpressureandmeanprimingvolumeafteraorticcrossclamp.ThechangetendencyofCEO2oftwogroupsweresimilarandwithoutsignificantdifference.Glu(a-v)ofnon-POCDgrouphadnodifferenceineverypoint,andGlu(a-v)ofPOCDgrouphadnodifferenceinT1andT2points,butvalueofGlu(a-v)ofPOCDgroupdecreasedobviouslyandhaddistinctdifferencewiththatofnon-POCDgroupinT3andT4points(P<0.05).ConclusionAge,CPBduration,andaorticcrossclampdurationwereriskfactorsofPOCD.BrainglucosemetabolismdisorderwaspossiblyoneofpathogenesisofPOCD.