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。

Correlation between Perioperative Brain Glucose Metabolism Disorder and Postoperative Cognitive Dysfunction after Heart Valve Replacement Operation

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（P0.05）,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（P0.05）.Conclusion Age,CPB duration,and aortic crossclamp duration were risk factors of POCD.Brain glucose metabolism disorder was possibly one of pathogenesis of POCD.