冠状动脉搭桥术后认知能力下降:风险修正及其对低风险人群筛查的意义

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Russian Open Medical Journal Pub Date : 2022-06-25 DOI:10.15275/rusomj.2022.0204
Rada S. Kovaltcova, N. N. Petrova, Sergei F. Zadvorev
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引用次数: 0

摘要

背景-术后认知功能障碍(POCD)是冠状动脉旁路移植术(CABG)的一个重要并发症。大量的数据表明,CABG手术风险高的患者存在POCD问题。低风险患者也不能完全避免这些并发症。评估稳定冠状动脉疾病停泵和开泵患者POCD的严重程度、持续时间、恢复程度和危险因素对于降低低手术风险患者的POCD风险至关重要。目的:分析择期低危冠脉搭桥患者POCD的发生率、严重程度、可逆性及危险因素。方法和结果:回顾性队列研究纳入79例手术风险低(平均EuroSCORE II死亡风险1.08±0.71%)的有泵(N=44)或无泵(N=35)选择性冠脉搭桥患者,观察期6个月。50%的患者发现cabg前认知障碍标志物,44%的患者表现为POCD。非体外循环CABG患者的MoCA评分比体外循环CABG患者的MoCA评分下降更明显(8天时-3.9±2.0比-2.2±2.0,p=0.018), 3周后恢复到CABG前的结果。基线MoCA评分<25被发现是8天认知能力下降更明显的预测因子。与MoCA相比,MMSE的预测价值较低。结论:无论使用MMSE还是MoCA测试,停泵和停泵CABG队列的POCD风险不同,前者的患病率明显更高。cabg后3周内观察到差异。在低风险选择性CABG队列中,CABG前MoCA评分<25与更明显的POCD相关。
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Post-Coronary Artery Bypass Grafting Cognitive Decline: Risk Modification And Implications For Screening In Low-Risk Population
Background — Postoperative cognitive dysfunction (POCD) is an important complication of coronary artery bypass grafting (CABG). Large amount of data points to the problem of POCD in patients with high surgical risk of CABG. Low-risk patients are not safe from these complications either. Assessment of the severity, duration of POCD, degree of recovery and risk factors in off- and on-pump patients with stable coronary artery disease is crucial in minimization of the POCD risk in patients with low surgical risk. Objective — to analyze incidence, severity, reversibility and risk factors of POCD in patients undergoing elective low-risk CABG. Methods and Results — The retrospective cohort study included 79 patients who underwent on-pump (N=44) or off-pump (N=35) elective CABG with low surgical risk (mean EuroSCORE II death risk 1.08±0.71%), with observation period of 6 months. Pre-CABG markers of cognitive impairment were found in 50% of patients, with 44% of patients demonstrating POCD. Patients who underwent off-pump CABG demonstrated more pronounced decline in MoCA score compared to on-pump (-3.9±2.0 vs. -2.2±2.0 at 8 days point, p=0.018), with regress to pre-CABG results after 3 weeks. Baseline MoCA score <25 was found to be a predictor for more pronounced cognitive decline at 8 days point. MMSE demonstrated less predictive value compared to MoCA. Conclusion — POCD risk differs in off-pump and on-pump CABG cohorts, with significantly higher prevalence in the former group, whether assessed using MMSE or MoCA tests. Differences are observed within 3 weeks post-CABG. Pre-CABG MoCA score <25 is associated with more pronounced POCD in low-risk elective CABG cohort.
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来源期刊
Russian Open Medical Journal
Russian Open Medical Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
0.90
自引率
0.00%
发文量
39
期刊介绍: Russian Open Medical Journal (RusOMJ) (ISSN 2304-3415) is an international peer reviewed open access e-journal. The website is updated quarterly with the RusOMJ’s latest original research, clinical studies, case reports, reviews, news, and comment articles. This Journal devoted to all field of medicine. All the RusOMJ’s articles are published in full on www.romj.org with open access and no limits on word counts. Our mission is to lead the debate on health and to engage, inform, and stimulate doctors, researchers, and other health professionals in ways that will improve outcomes for patients. The RusOMJ team is based mainly in Saratov (Russia), although we also have editors elsewhere in Russian and in other countries.
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