Correlation between perioperative psychological assessment and brain damage after cardiac surgery and other factors
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摘要:
目的探讨心脏围手术期焦虑抑郁状态与各个因素及术后发生脑损伤的相关性。 方法 采用Spearman相关分析心脏术前、术后患者的焦虑抑郁状态与反应脑功能损害的指标神经元特异性烯醇化以及术前、术后各个因素的相关性。 结果心脏手术患者围手术期存在轻度的焦虑抑郁状态，患者的焦虑抑郁评分与反应心脏功能的NYHA分级、术前的氧合指数、肝肾功能没有相关性，提示患者的焦虑抑郁状态主要由于对病情及手术的顾虑导致。 结论本研究同时也发现患者围手术期的焦虑抑郁状态与术后发生肝肾功能、脑损害无关。 Abstract:Objective To analyze the correlation between anxiety, depression status of patients before or after cardiac surgery and NSE. Methods We use Spearman correlation to explore the correlation between anxiety, depression status of patients before or after cardiac surgery and NSE. Results Patients with cardiac surgery had mild anxiety and depression during the perioperative period. The anxiety and depression score of patients had no correlation with NYHA grades, preoperative oxygenation index, and liver and kidney function. The anxiety and depression status of patients were mainly caused by concerns about the desease condition and surgery. Conclusion The preoperative anxiety and depression are not related to postoperative liver and kidney function and brain damage. -
Key words:
- cardiac surgery /
- anxiety /
- depression /
- hamilton anxiety scale /
- hamilton depression scale /
- Symptom Checklist 90
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表 1 患者一般情况及各个因素与NSE水平的相关性
一般情况项目 例数[n(%)] Mean±SD NSE P r 年龄（岁） − − − <0.01 0.379 19~44 24（28.6） 34±1.5 26.73±7.16 − − 45~70 60（71.4） 62±2.3 35.03±14.10 − − 性别 − − − 0.610 − 男 47（56.0） − 31.33±9.87 − − 女 37（44.0） − 34.36±15.89 − − 手术类型 − − − − − CABG 14（16.6） − − − − 先心 11（13.1） − − − − 瓣膜置换 63（75） − − − − 主动脉夹层 12（14.3） − − − − 粘液瘤清除 4（4.8%） − − − − ICU住院时间（d） 74 3.79±2.25 − 0.271 − 术后住院时间（d） 74 13.34±7.12 − 0.062 − 体表面积（m2） 84 1.63±0.19 − 0.033 -0.237 BMI（kg/m2） 84 22.26±3.66 − 0.378 − EF（%） 84 60.66±9.59 − <0.01 -0.390 CPB时间（min） 84 114.14±72.07 − 0.687 − 阻断时间（min） 84 87.19±44.68 − 0.361 − 乳酸 84 3.16±1.93 − 0.212 − NYHA分级 84 − − 0.001 -0.345 CAGB: 冠脉旁路移植术; CPB:体外循环; EF: 左室射血分数; NYHA: 美国纽约心脏病学会心功能分级. 
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表 2 术前SCL90、HAMA、HAMD评分与围手术期、NYHA分级及氧合指数相关性分析
相关因素 P 术前SCL90 术前HAMA 术前HAMD NYHA分级 0.135 0.491 0.368 插管时间 0.666 0.662 0.83 术前氧合指数 0.44 0.315 0.416 术后1 h氧合指数 0.372 0.439 0.076 术后12 h氧合指数 0.951 0.974 0.453 术后24 h氧合指数 0.984 0.389 0.119 术后48 h氧合指数 0.242 0.51 0.683
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表 3 术前SCL90、HAMA、HAMD评分与围手术期肝功能相关性分析
相关因素 P 术前SCL90 术前HAMA 术前HAMD ALT术前 0.491 0.186 0.812 ALT术后 0.637 0.984 0.963 ALT术后第1天 0.730 0.981 0.793 ALT术后第2天 -0.492 0.260 0.887 ALT术后第3天 0.614 0.368 0.858 AST术前 0.382 0.622 0.289 AST术后 0.990 0.391 0.862 AST术后第1天 0.707 0.513 0.964 AST术后第2天 0.392 0.383 0.936 AST术后第3天 0.258 0.298 0.829 ALT: 丙氨酸氨基转移酶; AST: 谷草转氨酶.
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表 4 术前SCL90、HAMA、HAMD评分与围手术期肾功能相关性分析
血肌酐水平 P 术前SCL90 术前HAMA 术前HAMD 术前 0.455 0.697 0.872 术后1 h 0.861 0.543 0.543 术后第1天 0.751 0.79 0.81 术后第2天 0.563 0.667 0.341 术后第3天 0.907 0.998 0.832
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表 5 术后SCL90、HAMA、HAMD评分与围手术期、NYHA分级及氧合指数相关性分析
相关因素 P 术后SCL90 术后HAMA 术后HAMD NYHA分级 0.460 0.932 0.801 插管时间 0.546 0.892 0.878 术前氧合指数 0.980 0.614 0.932 术后1 h氧合指数 0.996 0.923 0.288 术后12 h氧合指数 0.156 0.147 0.802 术后24 h氧合指数 0.837 0.607 0.354 术后48 h氧合指数 0.495 0.880 0.801
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表 6 术后SCL90、HAMA、HAMD评分与围手术期肝功能相关性分析
相关因素 P 术后SCL90 术后HAMA 术后HAMD ALT术前 0.931 0.184 0.758 ALT术后 0.590 0.263 0.381 ALT术后第1天 0.393 0.193 0.320 ALT术后第2天 0.420 0.208 0.491 ALT术后第3天 0.940 0.548 0.663 AST术前 0.601 0.313 0.914 AST术后 0.817 0.610 0.648 AST术后第1天 0.671 0.429 0.460 AST术后第2天 0.687 0.674 0.568 AST术后第3天 0.406 0.863 0.456
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表 7 术后SCL90、HAMA、HAMD评分与围手术期肾功能相关性分析
血肌酐水平 P 术后SCL90 术后HAMA 术后HAMD 术前 0.474 0.431 0.943 术后1 h 0.444 0.714 0.82 术后第1天 0.837 0.980 0.755 术后第2天 0.593 0.809 0.869 术后第3天 0.167 0.452 0.766
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[1] Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements[J]. Anesth Analg, 1999, 89(6): 1346-51. [2] Rothenhausler HB, Grieser B, Nollert G, et al. Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study[J]. Gen Hosp Psychiatry, 2004, 27(1): 1-13. [3] Navarro-Garcia M, Marin-Fernandez B, Carlos-Alegre CV, et al. Preoperative mood disorders in patients undergoing cardiac surgery: risk factors and postoperative morbidity in the intensive care unit[J]. Rev Esp cardiol, 2011, 64(11): 9-21. [4] Roach GW, Kanchuger M, Mangano CM, et al. Adverse cerebral outcomes after coronary bypass surgery[J]. N Engl J Med, 1996, 335(25): 1857-63. doi: 10.1056/NEJM199612193352501 [5] Ghaffary S, Hajhossein TA, Ghaeli P, et al. Association between perioperative parameters and cognitive impairment in post-cardiac surgery patients[J]. J Tehran Heart Cent, 2015, 10(2): 85-92. [6] Vilela Martin JF, Vaz Melo RO, de Sousa LP. Postoperative cognitive dysfunction after cardiac surgery[J]. Rev Bras Cir Cardiovasc, 2008, 23(2): 245-55. doi: 10.1590/S0102-76382008000200015 [7] van Harten AE, Scheeren TW, Absalom AR. A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia[J]. Anaesthesia, 2012, 67(3): 280-93. doi: 10.1111/j.1365-2044.2011.07008.x [8] Browne SM, Halligan PW, Wade DT, et al. Postoperative hypoxia is a contributory factor to cognitive impairment after cardiac surgery[J]. J Thorac Cardiovasc Surg, 2003, 126(4): 1061-4. doi: 10.1016/S0022-5223(03)00616-0 [9] Ingebrigtsen T, Romner B. Biochemical serum markers for brain damage: a short review with emphasis on clinical utility in mild head injury[J]. Restor Neurol Neurosci, 2003, 21(3/4): 171-6. [10] Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: executive summary and recommendations: a report of the American college of cardiology/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 1999, 100(13): 1464-80. doi: 10.1161/01.CIR.100.13.1464 [11] Newman MF, Kirchner JL, Phillips-Bute B, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery[J]. N Engl J Med, 2001, 344(6): 395-402. doi: 10.1056/NEJM200102083440601 [12] Selnes OA, Royall RM, Grega M, et al. Cognitive changes 5 years after coronary artery bypass grafting: is there evidence of late decline[J]. Arch Neurol, 2001, 58(4): 598-604. [13] Hernandez-Palazon J, Fuentes-Garcia D, Falcon-Arana L, et al. Assessment of preoperative anxiety in cardiac surgery patients lacking a history of anxiety: contributing factors and postoperative morbidity[J]. J Cardiothorac Vasc Anesth, 2017, 32(1): 236-44. [14] Martin CR, Thompson DR, Chan DS. An examination of the psychometric properties of the hospital anxiety and depression scale in Chinese patients with acute coronary syndrome[J]. Psychiatry Res, 2004, 129(3): 279-88. doi: 10.1016/j.psychres.2004.06.012 [15] Bruggemans EF. Cognitive dysfunction after cardiac surgery: pathophysiological mechanisms and preventive strategies[J]. Neth Heart J, 2013, 21(2): 70-3. doi: 10.1007/s12471-012-0347-x [16] Newman MF, Mathew JP, Grocott HP, et al. Central nervous system injury associated with cardiac surgery[J]. Lancet, 2006, 368(9536): 694-703. doi: 10.1016/S0140-6736(06)69254-4 [17] 彭立珍. 心脏手术患者术后不良精神反应的心理基础及情志顺势心理治疗研究[J]. 中国实用医药, 2016, 11(28): 279-80. [18] Chi YL, Li ZS, Lin CS, et al. Evaluation of the postoperative cognitive dysfunction in elderly patients with general anesthesia[J]. Eur Rev Med Pharmacol Sci, 2017, 21(6): 1346-54. [19] Silva FP, Schmidt AP, Valentin LS, et al. S100B protein and neuron-specific enolase as predictors of cognitive dysfunction after coronary artery bypass graft surgery: a prospective observational study[J]. Eur J Anaesthesiol, 2016, 33(9): 681-9. doi: 10.1097/EJA.0000000000000450 [20] Rasmussen LS, Christiansen M, Hansen PB, et al. Do blood levels of neuron-specific enolase and S-100 protein reflect cognitive dysfunction after coronary artery bypass[J]. Acta Anaesthesiol Scand, 1999, 43(5): 495-500. doi: 10.1034/j.1399-6576.1999.430502.x [21] Grubb NR, Simpson C, Sherwood RA, et al. Prediction of cognitive dysfunction after resuscitation from out-of-hospital cardiac arrest using serum neuron-specific enolase and protein S-100[J]. Heart, 2007, 93(10): 1268-73. doi: 10.1136/hrt.2006.091314 [22] Jz L, Li XZ, Wang XM, et al. Release of serum S-100beta protein and neuron-specific enolase after off-pump coronary artery bypass grafting with and without intracranial and cervical artery stenosis[J]. Ann Thorac Cardiovasc Surg, 2013, 93(27): 2152-4. [23] Tamura A, Imamaki M, Shimura H, et al. Release of serum S-100beta protein and neuron-specific enolase after off-pump coronary artery bypass grafting with and without intracranial and cervical artery stenosis[J]. Ann Thorac Cardiovasc Surg, 2011, 17(1): 33-8. doi: 10.5761/atcs.oa.09.01518 [24] Kofke WA, Konitzer P, Meng QC, et al. The effect of apolipoprotein E genotype on neuron specific enolase and S-100beta levels after cardiac surgery[J]. Anesth Analg, 2004, 99(5): 1323-5. [25] Peng LY, Xu LW, Ouyang W. Role of peripheral inflammatory markers in postoperative cognitive dysfunction (POCD): a meta-analysis[J]. PLoS One, 2013, 8(11): 79624-36. doi: 10.1371/journal.pone.0079624 [26] 何庆标, 黄 威, 王育明, 等. 体外循环心脏瓣膜置换术老年患者血浆谷氨酸和γ-氨基丁酸水平与术后认知障碍的关系[J]. 中国老年学杂志, 2018, 38(23): 5726-8. doi: 10.3969/j.issn.1005-9202.2018.23.037 [27] 汤海楠, 杨 薇. 紧张和焦虑对体外循环心脏手术患者术后认知功能的影响[J]. 中国实用神经疾病杂志, 2016, 19(11): 68-70. doi: 10.3969/j.issn.1673-5110.2016.11.036 [28] Marasco SF, Sharwood LN, Abrarnson MJ. No improvement in neurocognitive outcomes after off-pump versus on-pump coronary revascularisation: a meta-analysis[J]. European J Cardio-Thoracic Surg, 2008, 33(6): 961-70. doi: 10.1016/j.ejcts.2008.03.022 -
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