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冠状动脉搭桥术后的稳定认知:与经皮介入治疗及正常对照的比较

Stable cognition after coronary artery bypass grafting: comparisons with percutaneous intervention and normal controls.

作者信息

Rosengart Todd K, Sweet Jerry J, Finnin Eileen, Wolfe Penny, Cashy John, Hahn Elizabeth, Marymont Jesse, Sanborn Timothy

机构信息

Evanston Northwestern Healthcare, Evanston, Chicago, Illinois, USA.

出版信息

Ann Thorac Surg. 2006 Aug;82(2):597-607. doi: 10.1016/j.athoracsur.2006.03.026.

Abstract

BACKGROUND

Cognitive decline has been associated with coronary artery bypass grafting (CABG), but the extent to which these findings are related to the natural history of cognitive deficits in elderly patients with cardiac disease or have been influenced by the research methods used to determine abnormalities warrants further study.

METHODS

After excluding individuals with conditions known to cause brain dysfunction, individuals referred for percutaneous coronary intervention (n = 42) or CABG (n = 35) were compared with an age-matched and education-matched control group without clinical evidence of coronary artery disease (n = 44). These subjects underwent a battery of 14 neurocognitive tests at baseline (preoperatively) and at 3 weeks and 4 months postoperatively.

RESULTS

The majority of test scores for all three cohorts were within nonimpaired ranges at baseline and 3 weeks later. Change in impairment status from baseline to 3-week assessment was not associated statistically with type of treatment as referenced to clinical norms, and was associated with type of treatment on only one measure as referenced to control group performances. A further overall improvement in impairment status from 3 weeks' to 4 months' follow-up was seen in both CABG and percutaneous coronary intervention patients. Mean test scores were significantly worse in CABG patients versus percutaneous coronary intervention patients in 4 of 13 measures at 3 weeks' follow-up, but significant de novo impairment at 3 weeks' follow-up in the CABG group compared with the percutaneous coronary intervention and control groups was present in only one test. As assessed by reliable change methodology, impairment was statistically associated with type of treatment for only 1 of 13 measures.

CONCLUSIONS

As compared with changes seen in repeat testing of healthy control subjects and individuals who underwent percutaneous coronary intervention, clinically meaningful cognitive deterioration was not observed after CABG.

摘要

背景

认知功能下降与冠状动脉旁路移植术(CABG)有关,但这些发现与老年心脏病患者认知缺陷的自然病程相关的程度,或受到用于确定异常的研究方法影响的程度,值得进一步研究。

方法

在排除已知会导致脑功能障碍的个体后,将接受经皮冠状动脉介入治疗(n = 42)或CABG(n = 35)的个体与无冠状动脉疾病临床证据的年龄匹配和教育程度匹配的对照组(n = 44)进行比较。这些受试者在基线(术前)、术后3周和4个月接受了一系列14项神经认知测试。

结果

所有三个队列的大多数测试分数在基线和3周后均处于未受损范围内。从基线到3周评估时损伤状态的变化,按照临床规范参考,与治疗类型无统计学关联,按照对照组表现参考,仅在一项指标上与治疗类型有关联。在CABG和经皮冠状动脉介入治疗患者中,从3周随访到4个月随访时,损伤状态进一步整体改善。在3周随访时,13项指标中的4项中,CABG患者的平均测试分数明显低于经皮冠状动脉介入治疗患者,但与经皮冠状动脉介入治疗组和对照组相比,CABG组在3周随访时仅在一项测试中出现显著的新发损伤。通过可靠变化方法评估,13项指标中只有1项的损伤与治疗类型有统计学关联。

结论

与健康对照受试者和接受经皮冠状动脉介入治疗的个体的重复测试中观察到的变化相比,CABG后未观察到具有临床意义的认知恶化。

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