Suksompong Sirilak, Prakanratrana Ungkab, Chumpathong Saowapark, Sriyoschati Somchai, Pornvilawan Samphant
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
J Med Assoc Thai. 2002 Sep;85 Suppl 3:S910-6.
To evaluate neuropsychological dysfunction in patients following elective coronary artery bypass graft surgery at Siriraj Hospital.
One hundred and ten patients who were scheduled for elective coronary artery bypass graft surgery were included in this study. We used the Thai Mental State Examination (TMSE) in order to detectthe presence of cognitive impairment aftercoronary artery bypass graft surgery. The examinations were conducted on two consecutive occasions; first preoperatively, the day before surgery, secondly on the third - fifth postoperative day. The patients' clinical characteristics were assessed perioperatively.
The overall occurrence of neuropsychological deficit was 18.18 per cent. Predictors of neuropsychological dysfunction were older age and preexisting disease such as hypertension, hypercholesterolemia and renal insufficiency. Other risk factors such as gender, history of congestive heart failure, myocardial infarction, diabetes mellitus, dysrhythmia, cardiopulmonary bypass time, hemoglobin during cardiopulmonary bypass <7 g/dl, hemoglobin on admission to surgical cardiac care unit <10 g/dl, and atrial fibrillation arising after surgery were not significant.
Neuropsychological impairments after coronary artery bypass graft surgery are relatively common. This study did not find an increased incidence with respect to gender as other studies have done. However, long-term follow-up of these patients would be very valuable.
评估诗里拉吉医院择期冠状动脉搭桥手术后患者的神经心理功能障碍。
本研究纳入了110例计划接受择期冠状动脉搭桥手术的患者。我们使用泰国精神状态检查（TMSE）来检测冠状动脉搭桥手术后认知障碍的存在情况。检查在连续两个时间点进行；第一次是术前，手术前一天，第二次是术后第三天至第五天。围手术期评估患者的临床特征。
神经心理缺陷的总体发生率为18.18%。神经心理功能障碍的预测因素是年龄较大以及存在如高血压、高胆固醇血症和肾功能不全等既往疾病。其他风险因素，如性别、充血性心力衰竭病史、心肌梗死、糖尿病、心律失常、体外循环时间、体外循环期间血红蛋白<7 g/dl、入住心脏外科监护病房时血红蛋白<10 g/dl以及术后出现的房颤，均无显著意义。
冠状动脉搭桥手术后的神经心理损伤相对常见。本研究未发现如其他研究那样在性别方面发病率增加的情况。然而，对这些患者进行长期随访将非常有价值。
