Arrowsmith J E, Grocott H P, Reves J G, Newman M F
Department of Anaesthesia, Papworth Hospital, Papworth Everard, Cambridge, UK.
Br J Anaesth. 2000 Mar;84(3):378-93. doi: 10.1093/oxfordjournals.bja.a013444.
The neurological complications of cardiac surgery are associated with significantly increased mortality, morbidity and resource utilization. The use of new surgical techniques, introduction of wider indications for surgery and increased public expectation has led to an increase in the average age of cardiac surgical patients and an increased incidence of repeat procedures. With these changes has come an increased risk of neurological complications. The likelihood of perioperative stroke varies between 1% and 5% in most published series and is dependent on a multitude of risk factors. Of these, patient age, aortic atheroma, symptomatic cerebrovascular disease, diabetes mellitus and the type of surgery appear to be most important. Cognitive deterioration after cardiac surgery is far more common, affecting as many as 80% of patients a few days after surgery and persisting in one-third. Despite an increase in the age of the cardiac surgical population, the reported incidence of cognitive dysfunction after cardiac surgery seems to have fallen in recent years. Whether this is a real phenomenon or the result of changes in the use of psychometric testing and the definition of cognitive decline remains unclear. Recognition that certain equipment, surgical practices and patient factors contribute to neurological morbidity has prompted 'neuroprotective' interventions. Some of these (e.g. arterial line filtration and alpha-stat management) have been shown to improve outcome. Despite these measures, a small number of patients will inevitably sustain cerebral injury during otherwise successful cardiac surgery. Although pharmacological neuroprotection may, in the future, offer some of these patients an improved outcome, it is unlikely that any single agent will prevent neurological injury. In the meantime, the CNS complications of cardiac surgery remain a fertile area of research.
心脏手术的神经并发症与死亡率、发病率及资源利用的显著增加相关。新手术技术的应用、手术适应证的扩大以及公众期望的提高，导致心脏手术患者的平均年龄增加，再次手术的发生率上升。伴随这些变化，神经并发症的风险也增加了。在大多数已发表的系列研究中，围手术期卒中的发生率在1%至5%之间，且取决于多种危险因素。其中，患者年龄、主动脉粥样硬化、有症状的脑血管疾病、糖尿病以及手术类型似乎最为重要。心脏手术后的认知功能恶化更为常见，多达80%的患者在术后数天出现这种情况，且三分之一的患者持续存在。尽管心脏手术人群的年龄有所增加，但近年来报道的心脏手术后认知功能障碍的发生率似乎有所下降。这是真实现象还是心理测量测试使用变化及认知功能下降定义改变的结果尚不清楚。认识到某些设备、手术操作和患者因素会导致神经并发症，促使人们采取“神经保护”干预措施。其中一些措施（如动脉滤器和α稳态管理）已被证明可改善预后。尽管采取了这些措施，仍有少数患者在原本成功的心脏手术过程中不可避免地会发生脑损伤。尽管未来药物神经保护可能会改善部分此类患者的预后，但不太可能有单一药物能预防神经损伤。与此同时，心脏手术的中枢神经系统并发症仍是一个活跃的研究领域。
