摘要
目的探讨心脏瓣膜置换术体外循环期间混合静脉血氧饱和度(SvO_(2))、红细胞比容(HCT)与术后认知功能障碍(POCD)的相关性。方法回顾性分析该院2020年1月至2022年1月择期行体外循环下心脏机械瓣膜置换手术患者102例,以术后认知功能评估结果将患者分为POCD组和非POCD组。记录两组性别、体重、年龄、手术方式、文化程度、房颤、血脂、血糖、肝肾功能等情况;体外循环开始、人工降温后5 min、人工降温后30 min、复温时、复温后5 min、复温后10 min、复温后15 min、体外循环结束前1 min各时间点SvO_(2)和HCT;手术前、体外循环后5 min、体外循环结束时、术后1 d抽血查乳酸(lac)。结果两组体外循环开始、人工降温后5 min、人工降温后30 min、复温时、体外循环结束前1 min的SvO_(2)比较差异无统计学意义(P>0.05),复温后5 min、复温后10 min、复温后15 min的SvO_(2)比较差异有统计学意义(P<0.01),HCT随着SvO_(2)降低而降低(P<0.05)。两组患者术前、体外循环后5 min、术后1 d lac水平比较无明显差异(P>0.05),外循环结束时差异有统计学意义(P<0.05)。多因素分析显示,年龄>65岁、房颤、高血脂是POCD发生的独立危险因素(P<0.05)。结论SvO_(2)的连续性测量可以及时加强POCD预防与干预,减少其发生率。
Objective To investigate the correlation between continuous mixed vein oxygenation(SvO_(2)) and hematocrit(TCT) with postoperative cognitive dysfunction(POCD) during cardiopulmonary bypass(CPB) in heart valve replacement operation.Methods A total of 102 patients with elective mechanical heart valve replacement surgery in this hospital from January 2020 to January 2022 were retrospectively analyzed and divided into the POCD group and non-POCD group according to the postoperative cognitive function evaluation results.The sex, body weight, age, operation mode, cultural degree, atrial fibrillation, blood lipids, blood glucose, liver and renal function, etc.were recorded in the two groups.SvO_(2)and HCT were monitored at the beginning of CPB,at 5,30 min after artificial hypothermia, rewarming, at 10,15 min after rewarming, at 1 min after CPB end;the blood lactic acid(lac) level before operation, at 5 min after CBP and on postoperative 1 d was detected.Results SvO_(2)at the beginning of CPB,at 5,30 min after artificial hypothermia, rewarming and at 1 min after CPB had no statistical differences between the two groups(P>0.05).SvO_(2)had statistical differences among at 5,10,15 min after rewarming(P<0.05).The HCT level was decreased with the SvO_(2)level decrease(P<0.05).The lac level before operation, at 5 min after CPB and on postoperative 1 d had no significant difference between the two groups(P>0.05),which had statistical difference at the CPB end between the two groups(P<0.05).The multivariate analysis results showed that the age >65 years old, atrial fibrillation and high blood lipids were the independent risk factors of POCD occurrence(P<0.05).Conclusion Continuously detecting the SvO_(2)level could timely strengthen the POCD prevention and intervention, and reduce its occurrence rate.
作者
徐超
何松
徐达
许蓉
XU Chao;HE Song;XU Da;XU Rong(Department of Anesthesiology,Second Affiliated Hospital,Guizhou Medical University,Kaili,Guizhou 556000,China)
出处
《重庆医学》
CAS
2023年第2期185-189,共5页
Chongqing medicine
基金
贵州省卫生健康委科学技术基金项目(gzwkj2023-405)。
关键词
心脏瓣膜置换手术
混合静脉血氧饱和度
术后认知功能障碍
体外循环
heart valve replacement operation
mixed venous oxygenation
postoperative cognitive dysfunction
cardiopulmonary bypass
