Ille Rottraut, Lahousen Theresa, Schweiger Stefan, Hofmann Peter, Kapfhammer Hans-Peter
University Hospital of Psychiatry, Graz, Austria.
Cardiovasc Revasc Med. 2007 Jul-Sep;8(3):166-9. doi: 10.1016/j.carrev.2006.12.001.
Cardiac surgery may account for complications such as cognitive impairment, depression, and delay of convalescence. This study investigated the influence of different risk factors on cognitive performance, emotional state, and convalescence.
We included 83 patients undergoing cardiac surgery who had no indication of postoperative delirium. Psychometric testing was performed 1 day before and 7 days after surgery. Neuron-specific enolase (NSE) levels were measured 1 day before and 36 h after surgery.
Depression score increased after surgery, but patients showed no clinically significant depression. Postoperative cognitive performance correlated with postoperative depression level and preoperative cognitive performance. Forty-three percent of patients showed postoperative decline. Older patients exhibited a higher postoperative increase in NSE concentrations. Patients undergoing coronary artery bypass grafts or combined procedures exhibited more medical risk factors than those undergoing valve surgery alone. The number of bypass grafts was associated with time of hospitalization, and the number of patient-related risk factors correlated with stay in intensive care unit.
For elderly patients undergoing cardiac surgery, older age, total preexisting medical risk factors, and surgery duration seem to be the most important factors influencing cognitive outcome and convalescence. Results show that, also for patients without postoperative delirium, medical risk factors and intraoperative parameters can result in delay of convalescence.
心脏手术可能导致认知障碍、抑郁和康复延迟等并发症。本研究调查了不同风险因素对认知表现、情绪状态和康复的影响。
我们纳入了83例接受心脏手术且无术后谵妄迹象的患者。在手术前1天和手术后7天进行心理测量测试。在手术前1天和手术后36小时测量神经元特异性烯醇化酶（NSE）水平。
术后抑郁评分增加，但患者无临床显著抑郁。术后认知表现与术后抑郁水平和术前认知表现相关。43%的患者术后出现下降。老年患者术后NSE浓度升高幅度更大。接受冠状动脉搭桥术或联合手术的患者比仅接受瓣膜手术的患者表现出更多的医疗风险因素。搭桥数量与住院时间相关，患者相关风险因素的数量与重症监护病房停留时间相关。
对于接受心脏手术的老年患者，年龄较大、既往存在的医疗风险因素总数和手术持续时间似乎是影响认知结果和康复的最重要因素。结果表明，即使对于无术后谵妄的患者，医疗风险因素和术中参数也可能导致康复延迟。
