Carrascal Yolanda, Casquero Elena, Gualis Javier, Di Stefano Salvatore, Flórez Santiago, Fulquet Enrique, Echevarría Jose Ramon, Fiz Luis
Department of Cardiac Surgery, University Hospital of Valladolid, Valladolid, Spain.
Interact Cardiovasc Thorac Surg. 2005 Jun;4(3):216-21. doi: 10.1510/icvts.2004.092528. Epub 2005 Mar 29.
Neuropsychological dysfunction is a recognized complication after cardiac surgery. Attention, concentration, short term memory, and speed of mental processing are commonly involved. We evaluated prospectively the incidence of cognitive impairment in our population using a single test: Paced Auditory Serial Addition Test.
We analysed 132 patients (mean age 67 years) undergoing elective cardiac surgery (63.6% valvular, 25% coronary artery bypass grafting and rest mixed procedures) between January and June 2003. We did not include patients with previous history of cognitive impairment, major psychiatric disorders or stroke. Paced Auditory Serial Addition Test was performed before and after surgery (mean, 7 days) and in outpatient follow-up (mean, 4 months).
None of the patients suffered a major neurological complication. Mean preoperative Paced Auditory Serial Addition Test score was 27.04+/-11.05, 25.81+/-11.83 in immediate postoperative and 27.93+/-13.11 in follow-up. A significant postoperative neuropsychological dysfunction (test scale decline more than 1 S.D.) was shown in 45.5% of the patients. In 48.8%, decline persisted in follow-up. Valvular surgery and low preoperative Paced Auditory Serial Addition Test score were significant risk factors for immediate postoperative neuropsychological dysfunction. Valvular surgery and female sex were significant in multivariable analysis. Considering follow-up, older age is the only significant risk factor for cognitive impairment.
Using a single, quantifiable and easy and quickly applied test such as the Paced Auditory Serial Addition Test, we found an incidence of cognitive decline after cardiac surgery similar to that previously described. Valvular surgery and older age are the main risk factors for neuropsychological dysfunction in our population.
神经心理功能障碍是心脏手术后公认的并发症。注意力、专注力、短期记忆力和心理加工速度通常都会受到影响。我们使用一项单一测试——听觉节拍连续加法测试，对我们研究人群中认知障碍的发生率进行了前瞻性评估。
我们分析了2003年1月至6月期间接受择期心脏手术的132例患者（平均年龄67岁）（63.6%为瓣膜手术，25%为冠状动脉搭桥术，其余为混合手术）。我们未纳入有认知障碍、重大精神疾病或中风既往史的患者。在手术前和手术后（平均7天）以及门诊随访（平均4个月）时进行听觉节拍连续加法测试。
所有患者均未发生重大神经系统并发症。术前听觉节拍连续加法测试平均得分为27.04±11.05，术后即刻为25.81±11.83，随访时为27.93±13.11。45.5%的患者术后出现明显的神经心理功能障碍（测试量表得分下降超过1个标准差）。48.8%的患者在随访时仍存在下降。瓣膜手术和术前听觉节拍连续加法测试得分低是术后即刻神经心理功能障碍的重要危险因素。在多变量分析中，瓣膜手术和女性性别具有显著性。考虑到随访情况，年龄较大是认知障碍的唯一重要危险因素。
通过使用一项单一、可量化且易于快速应用的测试，如听觉节拍连续加法测试，我们发现心脏手术后认知功能下降的发生率与先前描述的相似。瓣膜手术和年龄较大是我们研究人群中神经心理功能障碍的主要危险因素。
