心脏手术后不同形式神经及缺血性并发症患者认知障碍的特征

Dmytro Mankovsky
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摘要

目的:研究心脏手术(CS)中各种形式的神经和缺血性并发症患者的认知功能障碍特征,并考虑在制定这类患者的康复计划中获得的数据。方法和对象。我们检查了700名在乌克兰卫生部心脏研究所接受人工循环CS手术后治疗的患者。样本量非常大,因此有可能将结果转移到患有CS的整个患者群体。在检查的患者中确定了以下组:a)术后期脑梗死(CI)患者86人,将该组患者的表现与术后期无心肌梗死的CS患者(同一样本中取614人)进行比较;b)有术后脑病体征的患者,217人(包括CI患者)。将该组患者的表现与来自同一样本的483例无术后脑病体征的CS患者的表现进行比较。本研究采用Trail Making Test (R. M. Reitan, Wolfson D., 1993);语言流畅性测试(M. D. Lezak, 1995);Stroop颜色干涉试验(J. R. Stroop, 1935);Luria的十个不相关单词记忆测试(Luria AR, 1969)。采用非参数Mann - Whitney检验对指标定量值的差异进行统计分析。结果。我们的研究发现CS患者存在显著的认知障碍。研究发现,术后出现缺血性和神经系统并发症会严重损害患者的认知功能。对认知领域最显著的负面影响是术后CI的存在:CI患者表现出严重的认知缺陷迹象。术后脑病患者也有认知功能障碍的表现,但该组患者的认知功能定量指标优于CI患者。结论。在为CS患者制定治疗、康复和预防措施时,应考虑到已确定的模式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Features of cognitive disorders in patients with different forms of neurological and ischemic complications who underwent cardiac surgery
Objective — to study the features of cognitive impairment in patients with various forms of neurological and ischemic complications who underwent cardiac surgery (CS), to consider the data obtained in the development of rehabilitation programs for this category of patients. Methods and subjects. We examined 700 patients who were treated at the Heart Institute of the Ministry of Health of Ukraine after undergoing CS with an artificial circulation procedure. The sample size is extremely large, and makes it possible to transfer the results to the entire population of patients who have suffered from CS. Among the examined patients the following groups were identified: a) patients with cerebral infarction (CI) in the postoperative period, numbering 86 people, the performance of patients in this group was compared with patients with CS without myocardial infarction in the postoperative period, numbering 614 people taken from the same sample); b) patients with signs of postoperative encephalopathy, numbering 217 people (which included patients with CI). The performance of patients in this group was compared with that of 483 patients with CS without signs of postoperative encephalopathy, taken from the same sample. The study was conducted using the Trail Making Test, TMT (R. M. Reitan, Wolfson D., 1993); Verbal Fluency Test, VFT (M. D. Lezak, 1995); Stroop Color Interference Test (J. R. Stroop, 1935); Luria’s test for memorizing ten unrelated words (Luria AR, 1969). Statistical analysis of differences in the quantitative values of indicators was performed using the nonparametric Mann‑Whitney test. Results. Our study found significant cognitive impairment in patients with CS. It was found that the presence of ischemic and neurological complications in the postoperative period significantly impairs cognitive function. The most significant negative impact on the cognitive sphere has the presence of CI in the postoperative period: patients with CI showed signs of severe cognitive deficits. Manifestations of cognitive deficits were also found in patients with postoperative encephalopathy, although the quantitative indicators characterizing cognitive functioning in this group of patients were better than in patients with CI. Conclusions. The identified patterns should be taken into account when developing treatment, rehabilitation and preventive measures for patients with CS.  
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