急性冠脉综合征合并心源性休克术后伴发认知功能障碍的影响因素

 目的 探讨急性冠脉综合征(acute coronary syndromes, ACS)合并心源性休克(cardiac shock, CS)患者各项潜在影响因素与伴发经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后认知功能障碍(post-operative cognitive dysfunction, POCD)的相关性。方法 选择医院2014-07至2016-01收治的ACS合并CS患者为研究对象。登记患者的一般情况、既往史、个人史等基线资料;统计急性生理与慢性健康评分(acute physiology and chronic health evaluation Ⅱ, APACHEⅡ)、主动脉内球囊反搏术(intra-aortic balloon pump, IABP)指标等。以ACS合并CS患者是否于入院1周内伴发POCD为因变量,上述影响因素为协变量,通过组间比较及二分类logistic回归分析患者伴发POCD的独立影响因素。结果 最终纳入48例ACS合并CS患者。其中18例于相应时间窗内伴发POCD,30例未见认知功能异常。两组患者干预措施具有可比性,除年龄及学历构成之外,其余基线资料均具有可比性。logistics回归显示:年龄、血清神经元特异性烯醇化酶(neuron-specific enolase, NSE)、学历构成、胸痛至开通血管时间、使用IABP、降低反搏频率时血压骤降、使用右美托咪啶进入回归模型(P＜0.05)。其中学历构成、使用IABP、使用右美托咪啶为独立保护因素;年龄、NSE、胸痛至开通血管时间、降低反搏频率时血压骤降为独立危险因素。结论 年龄、NSE、胸痛至开通血管时间、降低反搏频率时血压骤降为PCI后POCD的独立危险因素。

Correlations between acute coronary syndrome combined with cardiac shock and post-operative cognitive dysfunction

Objective To explore the correlations between influencing factors of acute coronary syndrome(ACS) due to cardiac shock(CS) and post-operative cognitive dysfunction(POCD).Methods Patients of ACS combined with CS treated in our hospital between July 2014 to January 2016 were enrolled in this study.Basic data on the patients' general health was recorded.Scores of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and intra-aortic balloon pump indicators were collected.Those factors were taken as covariates while whether patients of ACS combined with CS were accompanied by POCD within one week of hospitalization was taken as the dependent variable.Binary logistic regression analysis was performed to identify independent factors.Results Based on inclusion and exclusion criteria,48 cases of ACS combined with CS were ultimately included,among whom 18 were complicated with POCD in the corresponding period,and 30 had nocognitive dysfunction.Interventions were comparable between the two groups,so was the basic data except for age and levels of education.Binary logistics regression analysis showed that the level of education,use of IABP and dexmedetomidine were independent protective factors while age,NSE,the time taken to recanalize blood vessels after chest pain,and sudden drop of blood pressure in reducing counter pulsation frequency were independent risk factors.Conclusions Clinicians should be alert to these influencing factors,conduct timely screening and implement interventions as soon as possible in order to effectively prevent the occurrence of POCD,improve clinical outcomes of patients with ACS combined with CS.