Brain Function Monitoring And Risk Factors Analysis Of Postoperative Cognitive Dysfunction In Patients With Interventional Therapy Of Intracranial Vascular Stenosis

Objective:To preliminarily investigate the correlation between the trend of changes in brain function and POCD in patients with interventional therapy of intracranial vascular stenosis,and analyze the risk factors of POCD.Methods:82 patients with interventional therapy of intracranial vascular stenosis were selected as research subject,ASA?or?,aged 37?73 yr,BMI20?30kg/m².The patients were anesthetized with total intravenous anesthesia and monitored for brain function.The general information such as age,gender,years of education,preoperative complications,stenosis degree,length of hospital stay after operation and time of operation were collected.The vital signs and indicators of brain function were measured and recorded at each time,for instance,three minutes after entering the operating room?T0?,throat mask placement completed?T1?,implanting stents instantly?T2?,releasing stents instantly?T3?,one minute after recanalization of blood flow?T4?,three minutes after recanalization of blood flow?T5?,five minutes after recanalization of blood flow?T6?,ten minutes after recanalization of blood flow?T7?,pulling laryngeal mask immediately?T8?and leaving the operating room?T9?.NIHSS and MMSE were used to evaluate the nervous system and cognitive function before surgery?on the first day after surgery?at discharge and one month after surgery.Patients were separated into POCD group and non POCD group according to the occurrence of POCD.Regression analysis was carried out on the factors with statistically significant differences between groups to screen the independent risk factors of POCD.Results:1. In this study,82 patients completed psychosocial tests and follow-up,and 11 patients?13%?developed POCD.2. The compare of clinical data between both groups of patients:the age,hospital stay and the number of new cerebral infarction in POCD group were apparently more than those in non POCD group?P<0.05?,the years of education and the basic value of rScO₂ at the operative side of the POCD group were significantly lower than that of the non POCD group?P<0.05?.There were no statistic distinctness between the two groups in gender,body mass index,ASA grade,degree of stent stenosis,preoperative complications and operation time?P>0.05?.3. The contrast of vital signs between both groups of patients:the heart rate of POCD group at T2 was significantly lower than that in the non POCD group?P<0.05?.There were no statistic distinctness in HR,MAP and Sp O₂between POCD group and non POCD group at other time points?P>0.05?.4. The contrast of cerebrum function in both groups of patients:at T3-T9,the relative value of operative rScO₂ in the POCD group were apparently more than that in the non POCD group?P<0.05?.At other times,there were no statistic distinctness in relative value of rScO₂ between the two groups?P>0.05?.There were no statistic contrast in bilateral SEF between both groups?P>0.05?.Brain burst inhibition and abnormal density spectrum array were not found in both groups.5. The contrast of scores of cognitive function and nervous system:there were no statistic distinctness in preoperative NIHSS score between both groups?P>0.05?.At other times,the NIHSS scores of the POCD group were apparently more than those in the non POCD group?P<0.05?.and the MMSE scores of POCD group were apparently lower than those in the non POCD group?P<0.05?.6. Regression results:age and relative value of rScO₂ on the operative side were independent risk factors for POCD.Conclusions:The trend of cerebral function changes in interventional therapy of intracranial vascular stenosis is closely related to POCD.Age and relative value of rScO₂ on the operative side are independent risk factors for POCD in patients with interventional therapy of intracranial vascular stenosis.