The Independent Risk Factors Of Early Postoperative Cognitive Dysfunction After Coronary Artery Grafting Surgery

As we have known, postoperative cognitive dysfunction (POCD), is oneof the most common complications in on-pump and off-pump cardiac surgery.In general, POCD means mental status has changed after anesthesia andsurgery, it shows learning and memory, perception, attention, abstract thinking,spiritual movement rate, execution, visual construction capacity and quality ofsleep dysfunction, and it is synthesized by social decline, that is, changing inpersonality, social capability and skills. Over the past decades, we werecommitted to a profound study of the mechanism and etiology of POCD,many hypotheses had been proposed, and there were some factors which havebeen verified discussion. However, factors and mechanisms related POCDneed to be further experimented and demonstrated. Risk factors and long-termimpact of cognitive dysfunction after cardiac surgery were done to beanalyzed and discussed.It was from study of these patients who were undergoing CABG that waslearnt about the independent risk factors of POCD. This research followedclose to the line of the basic principles of statistical experimental design,collected data from the August2012to the November2013, in the SecondHospital of Hebei Medical University Heart and Great Vessels Surgery. It wasto describe the independent risk factors of POCD in patients undergoingCABG.Objective:Central nervous system complications is one of the most commoncomplications following cardiac surgery, it can affect the outcomes andmortality after cardiac surgery directly. The purpose of this study was to findthe independent risk factors of early impairment after CABG. Methods: We enrolled102patients undergoing CABG at the SecondHospital of Hebei Medical University Heart and Great Vessels Surgery, fromthe August2012to the November2013. Male78,female24, the preoperativepatients combined with diabetes23, immune system disorder23. Total102patients,3died of heart-related complications, remaining99did off-pumpcoronary artery bypass grafting (OPCABG). Patients who had CAD,6of themcomplicated with heart valve disease,3did CCABG+Mitral valvereplacement,2did CCABG+Aortic valve replacement, and1did CCABG+Resection of Left Atrial myxoma. Preoperative examinations were all in thenormal range. Preoperative physician medication target adjusted to a properlevel. Anesthesia was managed according to the situation of the patient.Preoperative night diazepam0.08~0.15mg/kg were taken orally, one hourbefore operation diazepam0.08~0.15mg/kg and metoprolol12.5~37.5mg/kgwere taken orally, morphine0.15~0.2mg/kg and scopolamine hydrobromide0.3mg were injected intramuscularly. The induction and maintenance ofanesthesia was achieved with a continuous infusion of propofol2~5mg·kgˉ1·hˉ1and remifentanil0.1~0.3ug·kgˉ1·minˉ1. ECG,SpO2, ABP, CVP,nasopharyngeal temperature, BIS and ETCO2were monitoredroutinely.Respiratory and circulatory stability were maintenanced. Patientswere tested1day preoperatively using the MMSE. This test were repeated at3rd and7th day postoperatively.Results:The occurrence rate of POCD is35.4%. Compared the occurrence ofpatients with or without cognitive dysfunction after cardiac surgery,CPB(P=0.023), with diabetes mellitus(P＜0.001), Cardiac ICU continuousinfusion of midazolam in cardiac ICU(P＜0.001), BIS(P=0.042), duration ofpostoperative tracheal intubation(P＜0.001) are independent risk factors ofearly POCD.Conclusion:CPB, with diabetes mellitus, continuous infusion of midazolam in cardiacICU, BIS and duration of postoperative tracheal intubation are the independent risk factors for early POCD.