目的: 探讨心脏瓣膜病患者术后远期认知功能障碍的发生现状和影响因素,为术后护理和康复指导提供依据。方法: 选取2022年5月-2023年5月入住弋矶山医院心胸外科248例心脏瓣膜病患者为研究对象,使用T-MoCA量表,评估患者术后第3个月有无发生术后认知功能障碍(postoperative cognitive dysfunction, POCD)。结果: 心脏瓣膜病患者术后第3个月POCD发生率为17.8%。单因素分析结果显示,年龄、文化程度、合并脑血管疾病、BMI、术前T-MoCA评分、麻醉时间、体外循环时间、机械通气时间、术后住院天数、总住院天数、术后入住ICU时间是患者术后第3个月发生POCD的影响因素(P＜0.05)。多因素Logistic回归分析显示,高龄、体外循环时间长、BMI高、术后入住ICU时间长、合并脑血管疾病为术后第3个月发生POCD的独立危险因素(P＜0.05)。结论: 老年心脏瓣膜病患者术后第3个月POCD的发生率较高,高龄、合并脑血管疾病、BMI高、术前T-MOCA评分低、麻醉时间、体外循环时间、机械通气时间、术后住院天数、总住院天数、术后入住ICU时间长的患者发生风险较高,应采取有效措施以降低患者术后POCD的发生率,改善患者预后,缩短患者术后的康复治疗与护理时间。
Objective: To explore the current situation and influencing factors of long-term cognitive dysfunction in patients with valvular heart disease after operation, and to provide basis for postoperative nursing and rehabilitation guidance. Methods: A total of 248 patients with valvular heart disease who were admitted to the Department of Cardiothoracic Surgery of Yijishan Hospital from May 2022 to May 2023 were selected as the research objects. The T-MoCA scale was used to evaluate the patients at the third month after operation to determine whether the patients had postoperative cognitive dysfunction (POCD). Results: The incidence of POCD in patients with valvular heart disease was 17.8% at 3 months after operation. The results of univariate analysis showed that age, education level, combined cerebrovascular disease, BMI, preoperative T-MoCA score, anesthesia time, cardiopulmonary bypass time, mechanical ventilation time, postoperative hospitalization days, total hospitalization days and postoperative ICU hospitalization time were the influencing factors of POCD in the third month after operation, and the difference was statistically significant (P＜0.05). Multivariate Logistic regression analysis showed that advanced age, long cardiopulmonary bypass time, high BMI, long postoperative ICU hospitalization time, and cerebrovascular disease were independent risk factors for POCD in the third month after surgery (P＜0.05). Conclusion: The incidence of cognitive dysfunction in elderly patients with valvular heart disease is higher in the third month after operation. Patients with advanced age, cerebrovascular disease, high BMI, low preoperative T-MOCA score, anesthesia time, cardiopulmonary bypass time, mechanical ventilation time, postoperative hospitalization days, total hospitalization days, and long postoperative ICU hospitalization time are at higher risk. Therefore, effective measures and means should be taken to reduce the incidence of POCD, improve the prognosis of patients, and shorten the postoperative rehabilitation treatment and nursing time.
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