The Variation Laws Of The Intraoperative Cerebral Oxygen Saturation And The Risk Factors Of Postoperative Cognitive Dysfunction In Different Adult Heart Surgery

Objective To observe the variation laws of the intraoperative cerebral oxygen saturation and the occurrence of postoperative cognitive dysfunction(POCD)in common heart surgery.Methods 60 patients with elective cardiac surgery,according to surgical methods,the patients were divided into 3 groups,which named Off-Pump Coronary Artery Bypass Surgery(OPCAB)group,coronary artery bypass grafting(cCABG)group and cardiac valve repair or replacement(Valve)group.All of the patients were monitored dynamically the indicators of hemodynamics and the cerebral oxygen saturation(rScO2)by near-infrared spectrometer during the whole surgery process,recorded the patient's rScO2 value at upon arrival in the operating theater(TO),after anesthesia induction(T1),after heparinization(T2),after complete cardiopulmonary bypass(CPB)/after the fixture was placed(T3),after the cardioplegic solution was perfused/began to match the bridge blood vessels(T4),10 minutes after stop cooling/anastomosed the bridge blood vessels(T7),5 minutes after weaning CPB/detected the bridge flow(T8),the end of the operation(T9),calculated the mean value of each time point and established the rSc02 baseline value.Hemodynamic parameters such as arterial blood pressure,central venous pressure,heart rate and so on were collected;flow perfusion of cardiopulmonary bypass,nasopharyngeal temperature,mixed venous oxygen saturation,blocking time and bypass time and so on;Laboratory indicators included blood routine,arterial blood gas analysis,serum lactate concentration and so on;Early postoperative recovery indicators included tracheal intubation time,ICU living time and hospital stay,postoperative mortality and various complications.The S100 protein and brain enolase(NSE)were detected by 2ml at 6 time points of after inducement,5min before CPB,the end of the operation,6h after operation,24h after operation and 48h after operation.The cognitive function of patients was assessed with the mini mental state scale(MMSE)at 1 day before operation and 5?7 days after operation.The variation laws of the intraoperative cerebral oxygen saturation and postoperative cognitive dysfunction were observed in all patients,to compare the difference between the three groups.Results Finally,43 patients completed all the tests,the OPCAB was performed in 10 cases,the CABG operation in 15 cases,and the valve operation in 18 cases.There were 15 patients with POCD after operation,and there was no significant difference between the three groups.There was no significant difference at each time point between the three groups of rScO2 in the left and right sides;The dynamic changes of rScO2 in group OPCAB was different from those in the other two groups;Compared between groups,T4,T6,T6 points in the OPCAB group were lower than the other two groups,the difference was significant(P<0.05).There was a negative correlation between Valve and nasopharyngeal temperature in group rSc02(r=-0.224,p=0.005);and was positively correlated with mean arterial blood pressure(r=0.190,p=0.019).Compared within group,the S100 protein of Valve group was lower than the basal value at the end of operation(P<0.05),the S100 protein in cCABG group was lower than that in Valve group at 24 and 48 hours after operation,the NSE in cCABG group was lower than that in OPCAB group at the end of operation,and the difference was significant(P<0.05).There was no significant difference between the three groups of the MMSE score before and after operation,in the sub score,the Valve group had lower directional force,and the difference was statistically significant(P<0.05).Conclusions The incidence of POCD in adult cardiac surgery was 34.9%.The variation curve of cerebral oxygen saturation in OPCAB group was different from those of patients undergone cardiopulmonary bypass.There was a negative correlation between rSc02 and nasopharyngeal temperature in Valve group;and a positively correlated with mean arterial blood pressure.The MMSE scores of the three groups were decreased in different degrees compared with those before operation.Objective To investigate the Incidence nd risk factors of postoperative cognitive dysfunction In patient received cardiac operation.Method A total of 60 patients received elective cardiac operation were included in this survey.POCD was diagnosis using the Mini-Mental State Examination.All enrolled patients were interviewed on the day before surgery and 5 days after operation.The patients were divided into two groups according to the results:the POCD groupand non POCD group.The information including age,sex,weight,education level,other diseases combined,left ventricular ejection fraction,duration of operations,duration of cardiopulmonary bypass,the lowest regional cerebral oxygen saturation,the lowest nasal temperature,the lowest hemoglobin concentration,the highest plasma glucose and lactate concentration during operation.,tracheal catheter retention time,intensive care unit staying time and in hospital time.All above parameters were compared between two groups,and then multivariate regression were used to identify the risk factors of POCD.Blood sample were collected at following time point to measure S100 protein and NSE.Results 43 patients completed this study.On 5 days after operation,15 cases showed POCD,with an incidence rate 34.9%.Compared to non POCD group,POCD group showed lower education level,longer clamp time and tracheal catheter retention time.Multivariate regression analysis indicated did not find meaningful positive risk factors.Conclusion The incidence of POCD was 34.9%on 5days after operation.No independent risk factors for POCD in patients underwent cardiac operation.