Mathisen Lars, Andersen Marit Helen, Hol Per Kristian, Tennøe Bjørn, Lund Christian, Russell David, Lundblad Runar, Halvorsen Steinar, Wahl Astrid Klopstad, Hanestad Berit Rokne, Fosse Erik
University of Oslo, Faculty Division Rikshospitalet/The Interventional Centre, Oslo, Norway.
J Thorac Cardiovasc Surg. 2005 Dec;130(6):1691-7. doi: 10.1016/j.jtcvs.2005.08.008.
Risk assessment is integral to patient selection and counseling before coronary artery revascularization. We studied the predictive ability of cerebral magnetic resonance imaging of preoperative and postoperative cerebral ischemic injury on self-reported physical and mental health at 3 months after coronary artery bypass surgery with or without use of cardiopulmonary bypass.
In a prospective clinical trial comparing on-pump and off-pump surgery, 120 patients responded to a questionnaire for self-report of angina (Canadian Cardiovascular Society scale) and physical and mental health status (Short Form 36) at baseline before preoperative cerebral magnetic resonance imaging. Preoperative sets of both magnetic resonance imaging and self-assessments were available for 103 (85.8%) patients. These patients were grouped according to classification of preoperative cerebral magnetic resonance imaging findings. Analysis of covariance determined the association of (1) preoperative magnetic resonance imaging status, (2) new postoperative cerebral lesions, and (3) actual use of cardiopulmonary bypass to physical and mental health.
At 3 months after surgical intervention, 98 of 103 patients completed follow-up. The analysis revealed an interaction effect of preoperative cerebral ischemic injury and use of cardiopulmonary bypass on physical health (F = 9.07, P = .003) independent of age. No independent effects on health status were found of baseline magnetic resonance imaging or new cerebral lesions at 3 months.
This study strongly suggests that the combination of preoperative cerebral ischemic injury and use of cardiopulmonary bypass can predict postoperative health status at 3 months. Cerebral magnetic resonance imaging might be a more specific indicator than age for preoperative assessment of vulnerability or resilience during rehabilitation after on-pump cardiac surgery.
风险评估是冠状动脉血运重建术前患者选择和咨询的重要组成部分。我们研究了在有或没有使用体外循环的冠状动脉搭桥手术后3个月，术前和术后脑缺血损伤的脑磁共振成像对自我报告的身心健康的预测能力。
在一项比较体外循环和非体外循环手术的前瞻性临床试验中，120名患者在术前脑磁共振成像前的基线时回答了一份关于心绞痛（加拿大心血管学会量表）以及身心健康状况（简短健康调查问卷36项）的自我报告问卷。103名（85.8%）患者有术前磁共振成像和自我评估的术前数据。这些患者根据术前脑磁共振成像结果分类进行分组。协方差分析确定了（1）术前磁共振成像状态、（2）术后新的脑损伤以及（3）体外循环的实际使用与身心健康之间的关联。
在手术干预后3个月，103名患者中的98名完成了随访。分析显示，术前脑缺血损伤和体外循环的使用对身体健康有交互作用（F = 9.07，P = 0.003），且不受年龄影响。未发现基线磁共振成像或3个月时新的脑损伤对健康状况有独立影响。
本研究强烈表明，术前脑缺血损伤与体外循环的联合使用可以预测术后3个月的健康状况。对于体外循环心脏手术后康复期间的脆弱性或恢复力的术前评估，脑磁共振成像可能是比年龄更具体的指标。
