Hogue Charles W, Freedland Kenneth, Hershey Tamara, Fucetola Robert, Nassief Abullah, Barzilai Benico, Thomas Betsy, Birge Stanley, Dixon David, Schechtman Kenneth B, Dávila-Román Victor G
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Stroke. 2007 Jul;38(7):2048-54. doi: 10.1161/STROKEAHA.106.480426. Epub 2007 May 17.
Neurocognitive dysfunction is an important source of patient morbidity and mortality after cardiac surgery that may disproportionately affect postmenopausal women. 17beta-Estradiol limits the extent of ischemic neuronal injury in a variety of experimental models. The purpose of this study was to evaluate whether perioperative administration of 17beta-estradiol to postmenopausal women reduces the frequency of neurocognitive dysfunction after cardiac surgery.
One hundred seventy-four postmenopausal women not on estrogen replacement therapy who were undergoing primary coronary artery bypass graft surgery and/or valve surgery with cardiopulmonary bypass were prospectively randomized to receive in a double-blinded manner either 17beta-estradiol or placebo beginning the day before surgery and continuing for 5 days postoperatively. The patients were evaluated before and after surgery with the National Institutes of Health Stroke Scale and a psychometric test battery.
There were no differences in the frequency of neurocognitive dysfunction (primary outcome) between patients randomized to perioperative 17beta-estradiol (n=86) and those randomized to placebo (n=88) 4 to 6 weeks after surgery (17beta-estradiol, 22.4% versus placebo, 21.4%, P=0.45). The mean scores on tests of psychomotor speed were worse in women in the 17beta-estradiol group than in the placebo group at the 4- to 6-week (P=0.005) postoperative testing sessions.
Perioperative treatment with 17beta-estradiol did not result in improved neurocognitive outcomes in postmenopausal women undergoing cardiac surgery.
神经认知功能障碍是心脏手术后患者发病和死亡的重要原因，可能对绝经后女性产生不成比例的影响。在多种实验模型中，17β-雌二醇可限制缺血性神经元损伤的程度。本研究的目的是评估围手术期给予绝经后女性17β-雌二醇是否能降低心脏手术后神经认知功能障碍的发生率。
174例未接受雌激素替代治疗、正在接受初次冠状动脉搭桥手术和/或体外循环下瓣膜手术的绝经后女性，被前瞻性地随机分为两组，采用双盲法，从手术前一天开始，术后持续5天，分别接受17β-雌二醇或安慰剂治疗。采用美国国立卫生研究院卒中量表和一套心理测量测试对患者进行手术前后评估。
术后4至6周，随机接受围手术期17β-雌二醇治疗的患者（n = 86）和随机接受安慰剂治疗的患者（n = 88）之间，神经认知功能障碍（主要结局）的发生率没有差异（17β-雌二醇组为22.4%，安慰剂组为21.4%，P = 0.45）。在术后4至6周的测试中，17β-雌二醇组女性的精神运动速度测试平均得分比安慰剂组差（P = 0.005）。
围手术期使用17β-雌二醇治疗并未改善接受心脏手术的绝经后女性的神经认知结局。
