摘要
目的 观察体外循环下心内直视手术对病人认知功能近期损害的情况并对相关因素进行分析。方法 在术前与术后的10～15 d用韦氏智力量表、Benton视觉保持测验对30例病人评估,病种包括法乐氏三联征及四联征矫治术各2例,房间隔缺损修补术4例,双腔右心室矫治术3例,风湿性心脏病二尖瓣置换术11例,主动脉瓣二尖瓣联合置换术8例。并对体外循环中所测数值与手术前后智商差值进行相关性分析。结果 (1)言语智商术后较术前明显下降(术前101±16,术后94±16,P<0.01),总智商亦明显下降(术前.104±16),术后100±15,P<0.01),操作智商未见下降。(2)术后领悟及总智商的差异与体外循环时的动脉流量呈正相关性(P<0.05)。(3)术后言语智商的下降与最低pH值呈正相关性(P<0.05),与.PaCO2值呈负相关性(P<0.05)。(4)Benton视觉保持测验提示手术对病人视觉记忆保持能力及视觉空间结构能力有较明显的损害。结论 亚低温对脑功能有一定保护作用,但术后近期仍有认知功能损害。体外循环下心内直视手术对大脑具广泛影响。体外循环时,动脉流量过大、氧流量过高及CO2的过度降低加重对大脑认知功能的损害。
Objective To investigate the effects of different factors associated with open heart surgery performed under cardiopulmonary bypass (CPB) on neurocognitive function.Methods Thirty patients (21 male, 9 female) aged 15-51 yr (34.71 ± 11.02 yr) undergoing open heart surgery for congenital heart disease or valve replacement under CPB were enrolled in the study. Exclusion criteria included (1) age < 15 yr, (2) the illiterate, (3) uncoorperative patients and (4) patients too ill to complete the postoperative testing. In all patients cognitive function was assessed preoperatively and 10-15 days after operation using Wechsler adult intelligence scale and Benton visual retention test. The correlation between the postoperative cognitive decline and the different factors associated with CPB including CPB time, aortic cross-clamping time, arterial blood flow, rectal TO, pH, PaCO2 was analyzed. Results (1) CPB time was 146 ± 74 min, aortic cross-clamping time 95 ± 61 min, arterial blood flow 4.0 ±0.5 L·min-1 , oxygen flow 2.7 ± 0.7 L·min-1 , rectal T0 31.4 ± 1.7℃, pH 7.34 ±0.05, PaO2 548 ± 80 mm Hg, PaCO2 43 ± 7 mm Hg and MAP 63 ± 12 mm Hg. (2) The verbal intelligence quotient (IQ) and the genera] decreased after operation(P < 0.01), but the performance IQ was not significantly affected. (3) The postoperative decrease in understanding and general IQ were positively correlated with arterial blood flow ( P < 0.05). (4) The postoperative decrease in verbal IQ was positively correlated with the lowest pH (P < 0.05) and negatively correlated with PaCO2 ( P < 0.05) . (5) Benton visual retention test showed that cardiac surgery with CPB significantly affected visual memory and visual space. Conclusion Moderate hypothermia can protect the brain during cardiac surgery with CPB, but cognitive decline still occur in the early postoperative period. Many factors associated with CPB can affect cognitive function including high arterial blood flow, high oxygen flow, low PaCO2.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2004年第2期101-104,共4页
Chinese Journal of Anesthesiology
基金
浙江省舟山市科技局资助项目
