Prasongsukarn Kriengchai, Borger Michael A
Division of Cardiovascular Surgery, Toronto General Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Semin Cardiothorac Vasc Anesth. 2005 Jun;9(2):153-8. doi: 10.1177/108925320500900209.
Neurologic injury is a common complication of cardiac surgery and is associated with significant morbidity, mortality, and resource utilization. The incidence varies widely according to the definition used, patient age, and complexity of surgery. The manifestations of neurologic injury are broad, ranging from subtle neurocognitive dysfunction to frank stroke. An increasing amount of evidence points to cerebral embolization during cardiopulmonary bypass (CPB) as the principal etiologic factor of these neurologic complications. Cerebral emboli may be composed of atherosclerotic debris, calcium, air, fat, platelet thrombi, or CPB tubing. Advancements in perfusion technology, CPB techniques and surgical strategies may lead to a reduction in neurologic injury during cardiac surgery. In the current paper, we discuss the pathophysiology of neurologic injury after cardiac surgery and methods of reducing cerebral embolization. Reducing emboli and neurologic injury during CPB requires a multidisciplinary approach that includes several simple diagnostic and therapeutic strategies. Reducing cerebral emboli should be a major goal for future research in the fields of cardiac anesthesia, surgery and perfusion.
神经损伤是心脏手术常见的并发症，与显著的发病率、死亡率及资源利用相关。根据所采用的定义、患者年龄及手术复杂性的不同，其发病率差异很大。神经损伤的表现多种多样，从轻微的神经认知功能障碍到明显的中风。越来越多的证据表明，体外循环（CPB）期间的脑栓塞是这些神经并发症的主要病因。脑栓子可能由动脉粥样硬化碎片、钙、空气、脂肪、血小板血栓或CPB管道组成。灌注技术、CPB技术及手术策略的进步可能会减少心脏手术期间的神经损伤。在本文中，我们讨论心脏手术后神经损伤的病理生理学及减少脑栓塞的方法。在CPB期间减少栓子和神经损伤需要多学科方法，包括几种简单的诊断和治疗策略。减少脑栓子应成为心脏麻醉、手术及灌注领域未来研究的主要目标。
