Millar K, Asbury A J, Murray G D
Department of Psychological Medicine, University of Glasgow Academic Centre, Gartnavel Royal Hospital, UK.
Br J Anaesth. 2001 Jan;86(1):63-7. doi: 10.1093/bja/86.1.63.
Conventional methodology to investigate cognitive impairment after coronary artery bypass graft (CABG) surgery leaves unclear the potential for pre-existing cognitive deficits to influence outcome. Individuals with pre-existing deficits may be more vulnerable to the effects of CABG, hence biasing the results of a typical prospective trial if account is not taken of their state. The present study examined the effect of pre-existing cognitive impairment upon cognitive outcome in 81 patients undergoing CABG. Patients performed the Stroop Neuropsychological Screening Test and other psychometric assessments prior to and at 6 days and 6 months after CABG. Those with pre-existing cognitive deficits were significantly more likely to display impairment at 6-day and 6-month follow-ups than were those without pre-existing deficits. Greater age and lower pre-morbid intelligence were also significant predictors of post-CABG deficit, confirming earlier findings. The results imply both that pre-existing cognitive impairments may render patients more vulnerable to post-operative deficits and that, in the absence of such pre-existing impairments, CABG surgery does not inevitably lead to later deficits. The study also replicated previous findings showing a similar influence of pre-existing depression upon emotional state after CABG. Overall, the results confirm the importance both of a patient's pre-existing cognitive and emotional states, and the methodology to assess them, in influencing outcome after cardiac surgery and the conclusions to be drawn as to the supposed adverse effects of the procedure.
研究冠状动脉搭桥术（CABG）后认知功能障碍的传统方法，尚不清楚术前已存在的认知缺陷对结果产生影响的可能性。术前就存在缺陷的个体可能更容易受到CABG手术影响，因此，如果不考虑他们的状态，就会使典型前瞻性试验的结果产生偏差。本研究调查了81例接受CABG手术患者术前存在的认知障碍对认知结果的影响。患者在CABG手术前、术后6天和6个月时进行了斯特鲁普神经心理学筛查测试及其他心理测量评估。术前就存在认知缺陷的患者在术后6天和6个月随访时出现认知障碍的可能性显著高于无术前缺陷的患者。年龄较大和病前智力较低也是CABG术后认知缺陷的重要预测因素，这证实了早期研究结果。研究结果表明，术前存在的认知障碍可能使患者更容易出现术后认知缺陷，而且在没有这种术前障碍的情况下，CABG手术不一定会导致后期认知缺陷。该研究还重复了先前的研究结果，即术前存在的抑郁情绪对CABG术后情绪状态也有类似影响。总体而言，研究结果证实了患者术前存在的认知和情绪状态及其评估方法在影响心脏手术后结果以及对该手术假定不良反应得出结论方面的重要性。
