Jensen Birte Ostergaard, Hughes Pia, Rasmussen Lars S, Pedersen Preben U, Steinbrüchel Daniel A
Department of Cardiothoracic Surgery, The Heart Center, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Circulation. 2006 Jun 20;113(24):2790-5. doi: 10.1161/CIRCULATIONAHA.105.587931. Epub 2006 Jun 12.
It has been suggested that the risk of cerebral dysfunction is less with off-pump coronary artery bypass grafting (OPCAB) than with conventional coronary artery bypass grafting (CCAB). However, evidence for this statement is preliminary, and additional insight is needed.
The study was a substudy of the randomized Best Bypass Surgery trial that compared OPCAB with CCAB treatment with respect to intraoperative and postoperative mortality and morbidity in patients with a moderate to high level of predicted preoperative risk. The outcome was cognitive function. A total of 120 elderly patients (mean age 76 years, SD 4.5 years) underwent psychometric testing before surgery and at a mean of 103 (SD 15) days postoperatively with a neuropsychological test battery that included 7 parameters from 4 tests. Cognitive dysfunction was defined as the occurrence of at least 2 of the 7 possible deficits. Secondary analysis was performed on the basis of the definition of a 20% decline in cognitive scores compared with baseline, and with z score analysis. Cognitive dysfunction was identified in 4 of the 54 patients (7.4%, 95% confidence interval [CI] 2.1% to 17.9%) in the OPCAB group and 5 of the 51 patients (9.8%, 95% CI 3.3% to 21.4%) in the CCAB group. We found no difference in incidence of cognitive dysfunction between the groups regardless of the definition applied.
In elderly high-risk patients, no significant difference was found in the incidence of cognitive dysfunction 3 months after either OPCAB or CCAB.
有人提出，非体外循环冠状动脉搭桥术（OPCAB）导致脑功能障碍的风险低于传统冠状动脉搭桥术（CCAB）。然而，这一说法的证据尚属初步，还需要更多的深入研究。
本研究是随机化最佳搭桥手术试验的一项子研究，该试验比较了OPCAB与CCAB治疗对术前预测风险为中度至高度的患者术中及术后死亡率和发病率的影响。观察结果为认知功能。共有120例老年患者（平均年龄76岁，标准差4.5岁）在手术前及术后平均103天（标准差15天）接受了心理测量测试，使用了一套神经心理学测试组合，其中包括来自4项测试的7个参数。认知功能障碍定义为7种可能缺陷中至少出现2种。基于与基线相比认知评分下降20%的定义以及z评分分析进行了二次分析。OPCAB组54例患者中有4例（7.4%，95%置信区间[CI]2.1%至17.9%）出现认知功能障碍，CCAB组51例患者中有5例（9.8%，95%CI 3.3%至21.4%）出现认知功能障碍。无论采用何种定义，我们发现两组间认知功能障碍的发生率均无差异。
在老年高危患者中，OPCAB或CCAB术后3个月认知功能障碍的发生率无显著差异。
