Gottesman Rebecca F, Wityk Robert J
Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Semin Neurol. 2006 Sep;26(4):432-9. doi: 10.1055/s-2006-948324.
Patients who undergo coronary artery bypass grafting (CABG) are at increased risk for brain injury. Surgical techniques have advanced so that the risk of neurological sequelae is decreased, but there remains significant morbidity and mortality related to the postoperative period as well as to the surgery itself. In addition, patients who undergo CABG have comorbidities or demographic factors that may increase their likelihood of developing neurological complications. Pathophysiological mechanisms of cerebral injury after CABG range from hemodynamic compromise to embolization, either intraoperatively or postoperatively. Biochemical markers such as S100 and neuron-specific enolase may play a role in the prediction of outcome after CABG, and because of this may help elucidate other potential risk factors. Specific neurological sequelae are discussed, such as stroke, with summaries of the apparent risk factors, as well as encephalopathy, seizure, and both short- and long-term cognitive deficits. Changes in surgical technique have led to some improvements, but there is no definitive information yet as to the role of some of these, such as the use of off-pump CABG. Other techniques such as the use of an arterial filter are discussed, as are their potential benefits in the prevention of neurological complications.
接受冠状动脉旁路移植术（CABG）的患者发生脑损伤的风险增加。手术技术已经取得进展，神经后遗症的风险有所降低，但术后以及手术本身仍存在显著的发病率和死亡率。此外，接受CABG的患者存在合并症或人口统计学因素，可能会增加其发生神经并发症的可能性。CABG后脑损伤的病理生理机制包括术中或术后的血流动力学损害以及栓塞。诸如S100和神经元特异性烯醇化酶等生化标志物可能在预测CABG后的预后中发挥作用，因此可能有助于阐明其他潜在风险因素。文中讨论了特定的神经后遗症，如中风，并总结了明显的风险因素，以及脑病、癫痫和短期及长期认知缺陷。手术技术的改变带来了一些改善，但对于其中一些技术的作用，如非体外循环CABG的使用，尚无确切信息。文中还讨论了其他技术，如使用动脉滤器，以及它们在预防神经并发症方面的潜在益处。
