An Investigation Of Cognitive Changes And The Influential Factors' Analysis Among The Patients Following Off-pump Coronary Artery Bypass Grafting

Objectives1.To investigate the prevalence of cognitive changes among the patients following off-pump coronary artery bypass grafting at 1 day before discharge and 3 months after operation.2.To explore the influential factors of cognitive changes after off-pump coronary artery grafting in order to provide some scientific references for early prevention.Methods59 patients who underwent off-pump coronary artery bypass grafting in the cardiac surgery of the First Affiliated Hospital of China Medical University from January,2008 to October,2008 were enrolled in this study by convenience sampling. With questionnaire survey,the Sociodemographic data were collected 2-3 days before operation,at the same time,had the patients' cognitive function,social support status and emotional state evaluated as well;Cognitive function was reassessed 1 day before discharge and 3 months after operation respectively and potential influential factors were recorded during patient's hospitalization.Compared the scores of the last two time points with the baseline's to determine whether the cognitive function changes or not. All data were analyzed by the SPSS 13.0 version statistical software,the statistical description included means,standard deviation,percentage etc.chi square test,t-test and logistic regression analysis were applied to explore the influential factors.Results1.Among the 59 cases who met the including and excluding criteria,2 cases dead after operation,1 case lost to follow-up at 3 months after operation,56 cases completed the assessments of cognitive function in three time points in all.12 cases occurred cognitive changes 1 day before discharge,incidence was 21.43%;6 cases occurred cognitive changes 3 months after operation,incidence was 10.71%.2.Comparison of data between the two groups of cognitive changes1 day before discharge:Age,educational level,diabetes mellitus history,cardiac function,mechanical ventilation time,intensive care unit stay time and complications after operation were statistically significantly different between the two groups.Data on gender,smoking,drinking and body mass index had no statistically significantly different between two groups.3 months after operation:Cognitive function 1 day before discharge,mechanical ventilation time and intensive care unit stay time were statistically significantly different between the two groups,other factors had no statistically significantly different between two groups.3.Non-conditional logistic regression results1 day before discharge:diabetes,complications and educational level(3 independent variables) finally remained in the equation(P＜0.05).Diabetes mellitus, complications after operation were the risk factors and educational level was the protective factor to cognitive changes.3 months after operation:Cognitive function 1day before discharge and mechanical ventilation time(2 independent variables) remained in the equation,but only the P-value of the former was less than 0.05. Cognitive function 1 day before discharge was the risk factor to cognitive changes.ConclusionsThe cognitive changes after off-pump coronary artery bypass grafting are affected by many factors and it is the outcome of interaction of age,educational level,cardiac function,diabetes meilitus,mechanical ventilation time,intensive care unit stay time and complications after operation.Comprehensive evaluate the cognitive changes' influential factors and identify high-risk groups have clinical significance for the prevention of cognitive changes.