Van Dijk Diederik, Jansen Erik W L, Hijman Ron, Nierich Arno P, Diephuis Jan C, Moons Karel G M, Lahpor Jaap R, Borst Cornelius, Keizer Annemieke M A, Nathoe Hendrik M, Grobbee Diederick E, De Jaegere Peter P T, Kalkman Cor J
Department of Anaesthesiology, University Medical Center, PO Box 85500 (HpN E03-511), 3508 GA Utrecht, the Netherlands.
JAMA. 2002 Mar 20;287(11):1405-12. doi: 10.1001/jama.287.11.1405.
Coronary artery bypass graft (CABG) surgery is associated with a decline in cognitive function, which has largely been attributed to the use of cardiopulmonary bypass (on-pump procedures). Cardiac stabilizers facilitate CABG surgery without use of cardiopulmonary bypass (off-pump procedures) and should reduce the cognitive decline associated with on-pump procedures.
To compare the effect of CABG surgery with (on-pump) and without (off-pump) cardiopulmonary bypass on cognitive outcome.
Randomized controlled trial conducted in the Netherlands of CABG surgery patients enrolled from March 1998 through August 2000, with 3- and 12-month follow-up.
Patients scheduled for their first CABG surgery (mean age, 61 years; n = 281) were randomly assigned to off-pump surgery (n = 142) or on-pump surgery (n = 139).
Cognitive outcome at 3 and 12 months, which was determined by psychologists (blinded for randomization) who administered 10 neuropsychological tests before and after surgery. Quality of life, stroke rate, and all-cause mortality at 3 and 12 months were secondary outcome measures.
Cognitive outcome could be determined at 3 months in 248 patients. Cognitive decline occurred in 21% in the off-pump group and 29% in the on-pump group (relative risk [RR], 0.65; 95% confidence interval [CI], 0.36-1.16; P =.15). The overall standardized change score (ie, improvement of cognitive performance) was 0.19 in the off-pump vs 0.13 in the on-pump group (P =.03). At 12 months, cognitive decline occurred in 30.8% in the off-pump group and 33.6% in the on-pump group (RR, 0.88; 95% CI, 0.52-1.49; P =.69). The overall standardized change score was 0.19 in the off-pump vs 0.12 in the on-pump group (P =.09). No statistically significant differences were observed between the on-pump and off-pump groups in quality of life, stroke rate, or all-cause mortality at 3 and 12 months.
Patients who received their first CABG surgery without cardiopulmonary bypass had improved cognitive outcomes 3 months after the procedure, but the effects were limited and became negligible at 12 months.
冠状动脉搭桥术（CABG）与认知功能下降有关，这在很大程度上归因于体外循环的使用（心脏停跳手术）。心脏稳定器有助于在不使用体外循环的情况下进行CABG手术（非体外循环手术），并应减少与心脏停跳手术相关的认知功能下降。
比较冠状动脉搭桥术（CABG）在有（心脏停跳）和无（非体外循环）体外循环情况下对认知结局的影响。
1998年3月至2000年8月在荷兰对接受CABG手术的患者进行的随机对照试验，随访3个月和12个月。
计划进行首次CABG手术的患者（平均年龄61岁；n = 281）被随机分配至非体外循环手术组（n = 142）或体外循环手术组（n = 139）。
3个月和12个月时的认知结局，由心理学家（对随机分组不知情）在手术前后进行10项神经心理学测试来确定。3个月和12个月时的生活质量、中风发生率和全因死亡率为次要结局指标。
248例患者在3个月时可确定认知结局。非体外循环组认知功能下降的发生率为21%，体外循环组为29%（相对危险度[RR]，0.65；95%置信区间[CI]，0.36 - 1.16；P = 0.15）。非体外循环组的总体标准化变化评分（即认知表现的改善）为0.19，体外循环组为0.13（P = 0.03）。在12个月时，非体外循环组认知功能下降的发生率为30.8%，体外循环组为33.6%（RR，0.88；95%CI，0.52 - 1.49；P = 0.69）。非体外循环组的总体标准化变化评分为0.19，体外循环组为0.12（P = 0.09）。在3个月和12个月时，体外循环组与非体外循环组在生活质量、中风发生率或全因死亡率方面未观察到统计学上的显著差异。
接受首次非体外循环冠状动脉搭桥术的患者在术后3个月时认知结局有所改善，但效果有限，在12个月时可忽略不计。
