体外循环术中高血糖对术后认知功能的影响(1)
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【摘要】 目的 研究体外循环(CPB)心脏手术中高血糖症与术后认知功能障碍的关系。方法 本院86例CPB下行心脏瓣膜置换术(CVR)或冠状动脉旁路移植术(CABG)的非糖尿病成年患者,在术前及术后6周用标准化神经系统检查进行认知功能评分,并在术中监测患者血糖水平,按照术中出现高血糖(>200 mg/dL)与否分为A、B两组,比较两组患者的术前术后认知功能评分,分析术中高血糖与术后认知功能障碍的关系。结果 术中出现高血糖的患者,与术中未出现高血糖的患者比较,术后认知功能评分显著降低,认知功能障碍发生率明显增加(P<0.01)。结论 在接受体外循环手术的患者中,术中高血糖是术后出现认知功能障碍的独立危险因素。
【关键词】体外循环;高血糖;认知功能障碍
Hyperglycemia during cardiopulmonary bypass on postoperative cognitive function
LIU Wei.Department of cardiovascular surgical,the First People’s Hospital of Shangqiu,Henan 476000,China
【Abstract】 Objective To study the cardiopulmonary bypass(CPB)hyperglycemia during cardiac surgery and postoperative cognitive dysfunction.Methods Had 86 cases of heart valve replacement surgery down CPB(CVR)or coronary artery bypass grafting(CABG)in non-diabetic adult patients before and after 6 weeks with a standardized neurological examination for cognitive function score and intraoperative monitoring of blood glucose levels,according to intraoperative hyperglycemia(>200 mg/dL)or divided into A,B groups were compared before and after surgery in patients with cognitive function scores of patients in the high blood sugar and postoperative cognitive dysfunction.Results The patients with high blood sugar occur,and surgery does not appear in patients with high blood sugar compared with postoperative scores were significantly lower cognitive function,cognitive dysfunction was significantly increased(P<0.01).Conclusion In patients receiving bypass surgery,intraoperative hyperglycemia postoperative cognitive dysfunction is an independent risk factor.
【Key words】Cardiopulmonary bypass; High blood sugar; Cognitive impairment
术中高血糖普遍存在于心脏外科手术过程中,尤其是体外循环手术中[1]。同样,体外循环术后早期神经性及精神性损伤的发生率亦较高[2],主要表现为认知功能减退。本文旨在通过分析我院2005~2009年间86例CPB下行心脏瓣膜置换术(VR)或冠状动脉旁路移植术(CABG)的非糖尿病成年患者的临床资料,探讨体外循环术中高血糖与术后认知功能障碍之间的关系。
1 资料与方法
1.1 临床资料 2005~2009年间我院86例CPB下行心脏
瓣膜置换术(VR)或冠状动脉旁路移植术(CABG)的成年患者。所有患者术前均完善各项检查,排除脑血管疾病、肾脏疾病、精神疾病、糖尿病、难以控制的高血压、颈动脉狭窄,并用标准化神经系统检查进行认知功能评分。本组86例患者中男52例,女34例,年龄48~77岁,平均(58.2±12.6)岁,二尖瓣或主动脉瓣膜置换术40例,二尖瓣并主动脉瓣置换术5例,CABG 31例。 ......
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