术后认知功能障碍对心脏瓣膜置换手术患者康复的影响

段振馨; 陈芳; 钟河江; 段光友; 王杨; 卢鹏; 蒋学涛; 杜智勇; 李洪

doi:10.16016/j.1000-5404.201903212

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术后认知功能障碍对心脏瓣膜置换手术患者康复的影响

临床医学 | 更新时间：2026-01-09

- 术后认知功能障碍对心脏瓣膜置换手术患者康复的影响
- Effect of postoperative cognitive dysfunction on rehabilitation of patients after cardiac valve replacement surgery
- 第三军医大学学报 2019年41卷第11期页码：1077-1082
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院麻醉科
- 作者简介：
  
  [李洪，E-mail:lh78553@163.comLI Hong, E-mail:lh78553@163.com
- 基金信息：
  
  第三军医大学新桥医院临床科研基金(2015YLC09)
- DOI：10.16016/j.1000-5404.201903212
  中图分类号： R493;R654.2;R741
- 收稿：2019-03-25，
  
  修回：2019-03-29，
  
  纸质出版：2019-06-15
- 稿件说明：
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段振馨, 陈芳, 钟河江, 等. 术后认知功能障碍对心脏瓣膜置换手术患者康复的影响[J]. 第三军医大学学报, 2019,41(11):1077-1082.

Zhenxin DUAN, Fang CHEN, Hejiang ZHONG, et al. Effect of postoperative cognitive dysfunction on rehabilitation of patients after cardiac valve replacement surgery[J]. Journal of Third Military Medical University, 2019, 41(11): 1077-1082.
段振馨, 陈芳, 钟河江, 等. 术后认知功能障碍对心脏瓣膜置换手术患者康复的影响[J]. 第三军医大学学报, 2019,41(11):1077-1082. DOI： 10.16016/j.1000-5404.201903212.

Zhenxin DUAN, Fang CHEN, Hejiang ZHONG, et al. Effect of postoperative cognitive dysfunction on rehabilitation of patients after cardiac valve replacement surgery[J]. Journal of Third Military Medical University, 2019, 41(11): 1077-1082. DOI： 10.16016/j.1000-5404.201903212.

摘要

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(

=50)和N组(

=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

① P组患者的ICU住院时间[P组(3.9±1.6)d

N组(3.3±0.7)d，

=0.012

]

和总住院时间[P组(23.1± 7.3)d，N组(19.5±4.1)d，

=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)，

=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。

Abstract

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 (

=50).

Results

① The patients of group

had significantly longer lengths of ICU stay (3.9±1.6

3.3±0.7 d

=0.012) and of hospital stay (23.1±7.3

19.5±4.1 d

=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

than the group

(2.9±1.1

3.4±0.8

=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.

关键词

Keywords

references

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