目的:本研究旨在探讨心脏移植患者术后神经认知障碍(NCD)的发生情况及危险因素。
方法:分析76例心脏移植患者的临床资料,包括性别,年龄,高度,体重,教育水平,左心室射血分数(LVEF),每搏输出量(SV),移植持续时间,和移植前病史.使用简易精神状态检查(MMSE)和蒙特利尔认知评估(MoCA)量表评估认知功能。根据是否存在认知功能障碍,将患者分为认知正常和受损组。并比较他们的认知功能评分。采用多因素logistic回归分析心脏移植患者术后认知功能障碍的独立危险因素。
结果:76例心脏移植患者中有48例出现认知功能障碍,代表63.2%的发病率。心脏移植受者的认知障碍主要影响多个认知领域。Logistic回归分析确定年龄(OR=1.057,95%CI1.002-1.115),性别(OR=.200,95%CI.044-.919),教育水平(OR=.728,95%CI.600-.883),LVEF(OR=.891,95%CI.820-.969),糖尿病病史(OR=7.674,95%CI1.317~44.733)是心脏移植受者术后NCD的独立危险因素(P<0.05)。
结论:研究发现心脏移植患者术后NCD的发生率很高,性别,年龄,教育水平,LVEF,糖尿病病史是重要的危险因素。针对这些危险因素的早期识别和干预可能有助于预防移植后患者的NCD并改善长期预后。
OBJECTIVE: This study aimed to investigate the occurrence and risk factors of postoperative neurocognitive disorder (NCD) in patients who underwent heart transplantation.
METHODS: Seventy-six heart transplant patients were analyzed for clinical data including gender, age, height, weight, education level, left ventricular ejection fraction (LVEF), stroke volume (SV), transplantation duration, and pretransplant medical history. Cognitive function was assessed using the mini-mental status examination (MMSE) and Montreal cognitive assessment (MoCA) scales. Patients were categorized into cognitively normal and impaired groups based on the presence or absence of cognitive dysfunction, and their cognitive function scores were compared. Multivariate logistic regression was used to identify independent risk factors for cognitive impairment in postoperative cardiac transplant patients.
RESULTS: Cognitive dysfunction was observed in 48 out of 76 heart transplant patients, representing an incidence of 63.2%. Cognitive impairment in heart transplant recipients predominantly affected multiple cognitive domains. Logistic regression analysis identified age (OR = 1.057, 95% CI 1.002-1.115), gender (OR = .200, 95% CI .044-.919), education level (OR = .728, 95% CI .600-.883), LVEF (OR = .891, 95% CI .820-.969), and history of diabetes (OR = 7.674, 95% CI 1.317-44.733) as independent risk factors for postoperative NCD in heart transplant recipients (P < .05).
CONCLUSIONS: The study found a high incidence of postoperative NCD in heart transplant patients, with gender, age, education level, LVEF, and diabetes history being significant risk factors. Early identification and intervention targeting these risk factors may help prevent NCD in postheart transplant patients and improve long-term outcomes.