摘要
目的通过Meta分析了解颈动脉内膜剥脱术(CEA)后认知功能障碍(CD)的患病率,并探讨引起CD的主要危险因素,为CD的防治提供科学依据。方法通过检索国内外数据库查找关于CEA术后CD及其影响因素相关文献,同时追索纳入文献的参考文献,时限建库至2018年7月。采用Stata14.0、RevMan5.3软件对各研究结果进行Meta分析。结果最终纳入15篇文献,累计病人1941例。CEA术后3个月内CD患病率为16%(I2=80.6%,95%CI为0.13~0.20,P<0.01)。进一步亚组分析显示,术后1d、1个月、3个月CD患病率分别为21%(I2=22.8%,95%CI为0.19~0.24,P<0.001)、11%(I2=22.8%,95%CI为0.09~0.13,P<0.001)、30%(I2=32.1%,95%CI为0.18~0.41,P<0.001)。共纳入16个CD相关因素,其中3个因素有统计学意义,分别为术后高血压(OR=23.09,95%CI为8.95~59.52,P<0.001,Nfs>10)、他汀药物使用(OR=0.61,95%CI为0.43~0.86,P=0.004,Nfs>10)、颈内动脉(ICA)狭窄程度(WMD=3.31,95%CI为0.55~6.06,P=0.02,Nfs<10)。结论CEA术后CD患病率较高,可达11%~30%,其发生机制与脑灌注损伤或炎性反应相关性较大。其中术后高血压是CD重要的危险因素,而使用他汀药物对CD具有一定的预防作用。
Objective To investigate the prevalence of cognitive dysfunction(CD) after carotid endarterectomy(CEA) by a meta-analysis,and to explore the major risk factors for CD after CEA,so as to provide some scientific basis for the prevention and treatment of CD. Methods The related literatures on CD and its influencing factors after CEA were searched in domestic and foreign databases. The time limit was from the establishment of the database to July 2018. The datas were analyzed by Stata 14.0 and RevMan 5.3 software. Results A total of 15 articles were eventually enrolled,including 1941 patients. The prevalence of CD within 3 months after CEA was 16%( I2= 80.6%,95% CI 0.13-0.20, P<0.01). Further subgroup analysis showed that the prevalence rates of CD 1 day,1 month and 3 months after operation were 21%( I2= 22.8%,95% CI :0.19-0.24, P <0.001),11%( I2= 22.8%,95% CI :0.09-0.13, P <0.001),30%( I2= 32.1%,95% CI :0.18-0.41, P <0.001) respectively. A total of 16 influencing factors associated with CD were included,three of which were statistically significant, including postoperative hypertension( OR=23.09,95% CI :8.95-59.52, P < 0.001,Nfs>10),statins use( OR = 0.61,95% CI :0.43-0.86, P=0.004),Nfs>10),stenosis of internal carotid artery(ICA)(WMD=3.31,95% CI :0.55-6.06, P = 0.02,Nfs<10). Conclusions The prevalence of CD after CEA is 11%- 30%,and the mechanism might be closely related to cerebral perfusion injury or inflammatory reaction. Postoperative hypertension is an important risk factor for CD,but statins show a certain preventive effect on it.
作者
章杰
张喜成
韦润泽
彭艺
ZHANG Jie;WEI Run-ze;ZHANG Xi-cheng;PENG Yi(Dalian Medical University,Dalian 116044,China;Department of Vascular Surgery,Subei People's Hospital,Yangzhou 225002,China)
出处
《实用老年医学》
CAS
2019年第9期907-911,共5页
Practical Geriatrics
