Stump David A., Kon Neal A., Rogers Anne T., Hammon John W.
Department of Anesthesia, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157.
Echocardiography. 1996 Sep;13(5):555-558. doi: 10.1111/j.1540-8175.1996.tb00935.x.
The dramatic decline in mortality related to cardiac surgery has resulted in over 330,000 surgeries involving cardiopulmonary bypass (CPB) being performed yearly in the United States. Although few patients die as a result of cardiac surgery, over two thirds of the patients demonstrate evidence of acute neuropsychological dysfunction postoperatively. The potential mechanisms contributing to post-CPB neuropsychological deficits are many, but two major inter-related etiologic factors, hypo-perfusion and emboli, are suggested as the probable culprits. If embolism is the cause of the deficits, increasing cerebral perfusion would deliver more emboli and increase the amount and severity of injury. Conversely, if hypoperfusion is the cause of the injury, then decreasing brain blood flow to minimize embolic delivery would increase the likelihood of perfusion injury. By monitoring the carotid arteries of patients undergoing coronary artery bypass graft surgery, we have determined the frequency and quantity of embolic signals that occur during CPB. Although we have not been able to determine the nature of the embolus, gaseous or solid, we have demonstrated a relationship between the overall embolic load and the probability of having NP dysfunction. (ECHOCARDIOGRAPHY, Volume 13, September 1996)
与心脏手术相关的死亡率显著下降，使得美国每年有超过33万例涉及体外循环（CPB）的手术得以开展。尽管因心脏手术死亡的患者很少，但超过三分之二的患者术后出现急性神经心理功能障碍的迹象。导致CPB后神经心理缺陷的潜在机制众多，但两个主要的相互关联的病因因素，即灌注不足和栓子，被认为是可能的罪魁祸首。如果栓塞是缺陷的原因，增加脑灌注会输送更多栓子并增加损伤的数量和严重程度。相反，如果灌注不足是损伤的原因，那么减少脑血流量以尽量减少栓子输送会增加灌注损伤的可能性。通过监测接受冠状动脉搭桥手术患者的颈动脉，我们确定了CPB期间出现的栓塞信号的频率和数量。尽管我们无法确定栓子的性质，是气态还是固态，但我们已经证明了总体栓塞负荷与发生神经心理功能障碍可能性之间的关系。（《超声心动图》，第13卷，1996年9月）
