Ieva Norkiene, Samalavicius Robertas, Misiūriene Irina, Valaikiene Jurgita, Baublys Alis, Uzdavinys Giedrius
Centre of Anestesiology, Intensive Care, and Pain Treatment, Clinics of Santariskes, Vilnius University Hospital, Lithuania.
Medicina (Kaunas). 2004;40 Suppl 1:66-9.
Neurocognitive dysfunction still remains a frequent problem after heart surgery, complicating early recovery and strongly affecting postoperative quality of life. The aim of our study was to determine incidence of cognitive dysfunction after coronary artery bypass grafting for patients of low risk group and to find operative and postoperative factors associated with early cognitive impairment.
Using exclusion criteria, which are known as risk factors for postoperative neurological complications we selected a group of 30 coronary artery bypass grafting patients. The day before surgery and 7 to 8 days after operation we evaluated cognitive function of each patient using MMSE and standardized test battery of five neuropsychological tests. The incidence of cognitive decline was evaluated using composite z scores and 1 SD criteria. Preoperative ultrasound screening of asymptomatic carotid artery was performed for each patient.
Early postoperative cognitive dysfunction was present in 13 (46.3%) of patients. Patients with cognitive decline more often had asymptomic, hemodynamicly significant carotid artery stenosis. Duration of operation and coronary artery bypass time was longer in cognitive dysfunction group. As well there were more grafts performed to this group of patients. We noticed a relationship between lower temperature during coronary artery bypass and cognitive impairment.
Incidence of cognitive dysfunction for patients of low risk group was 46.3%. Cognitive decline was associated with prolonged coronary artery bypass, operation time and number of grafts.
心脏手术后神经认知功能障碍仍然是一个常见问题，它使早期恢复复杂化，并严重影响术后生活质量。我们研究的目的是确定低风险组患者冠状动脉搭桥术后认知功能障碍的发生率，并找出与早期认知障碍相关的手术及术后因素。
我们采用已知为术后神经并发症危险因素的排除标准，选取了30例冠状动脉搭桥患者。在手术前一天以及术后7至8天，我们使用简易精神状态检查表（MMSE）和一套由五项神经心理学测试组成的标准化测试组合对每位患者的认知功能进行评估。使用综合z分数和1个标准差标准评估认知功能下降的发生率。对每位患者进行无症状颈动脉的术前超声筛查。
13例（46.3%）患者出现术后早期认知功能障碍。认知功能下降的患者更常出现无症状的、血流动力学上有意义的颈动脉狭窄。认知功能障碍组的手术时间和冠状动脉搭桥时间更长。并且该组患者进行的移植手术更多。我们注意到冠状动脉搭桥期间较低的体温与认知障碍之间存在关联。
低风险组患者认知功能障碍的发生率为46.3%。认知功能下降与冠状动脉搭桥时间延长、手术时间以及移植手术数量有关。
