Qian Yi-ning, Zhang Zhuo, Meng Xu
Department of Neurology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2005 Jun 1;85(20):1400-2.
To investigate the effects of different factors associated with open heart surgery under cardiopulmonary bypass (CPB) on neurocognitive function.
The cognitive capacity of 50 patients undergoing open heart surgery under CPB were studied on the day before operation and the 14th day postoperatively with Basic Cognitive Capacity Test battery, including 7 subtest: Digit Discrimination, Mental Arithmetic, Chinese Character Rotation, Digit Working Memory, Dual-word recognition, Tri-digit Recognition, and Meaningless Figure Recognition. The correlation between the postoperative cognitive decline and the factors associated with CPB was analyzed.
The total score of the Basic Cognitive Capacity Test 14 days postoperatively in 31 out of the 50 patients (62%) was 50 +/- 13, significantly lower than the preoperative score (54 +/- 10, P < 0.01), the decline being especially marked in Digit Discrimination, Digit Working Memory, and Dual-word Recognition (all P < 0.01). The postoperative decrease in cognitive function was correlated with age (P < 0.05), CPB time (P < 0.01), rewarming rate (P < 0.01), and the highest PaCO(2) (P < 0.05).
The incidence of cognitive dysfunction is higher in patients undergoing open heart surgery with CPB during the early postoperative period. Shortening CPB time, slowing rewarming, and appropriately increasing the level of PaCO2 will help to degrade the possibility of cognitive dysfunction after open heart surgery.
探讨体外循环（CPB）下心内直视手术相关不同因素对神经认知功能的影响。
采用基本认知能力测验组合，对50例CPB下心内直视手术患者在术前1天及术后14天进行认知能力研究，该测验组合包括7个分测验：数字辨别、心算、汉字旋转、数字工作记忆、双词识别、三位数识别及无意义图形识别。分析术后认知功能下降与CPB相关因素之间的相关性。
50例患者中31例（62%）术后14天基本认知能力测验总分是50±13，显著低于术前分数（54±10，P<0.01），在数字辨别、数字工作记忆及双词识别方面下降尤为明显（均P<0.01）。术后认知功能下降与年龄（P<0.05）、CPB时间（P<0.01）、复温速率（P<0.01）及最高动脉血二氧化碳分压（PaCO₂）（P<0.05）相关。
CPB下心内直视手术患者术后早期认知功能障碍发生率较高。缩短CPB时间、减慢复温速度及适当提高PaCO₂水平有助于降低心内直视手术后认知功能障碍的发生可能性。
