Hogue Charles W, Fucetola Robert, Hershey Tamara, Nassief Abullah, Birge Stanley, Dávila-Román Victor G, Barzilai Benico, Thomas Betsy, Schechtman Kenneth B, Freedland Kenneth
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Anesth Analg. 2008 Jul;107(1):21-8. doi: 10.1213/ane.0b013e3181606a65.
Women are prone to neurological complications after cardiac surgery. We have previously reported that treatment perioperatively with the neuroprotectant steroid 17beta-estradiol did not improve neurocognitive end-points 4 to 6 wk after surgery for elderly women. In this study, we evaluated the influence of early postoperative neurocognitive dysfunction on quality of life in postmenopausal women undergoing cardiac surgery and whether it is impacted by perioperative 17beta-estradiol treatment.
One hundred seventy-four postmenopausal women randomly received 17beta-estradiol or placebo in a double-blind manner beginning the day before surgery and continued until the fifth postoperative day. The patients underwent psychometric testing using a standard battery before surgery and again 4 to 6 wk and 6 mo postoperatively. Quality of life was assessed at baseline and 6 mo after surgery with the SF-36 questionnaire and the Lawton instrumental activities of daily living scale.
Complete data were available from 108 women of whom 13% demonstrated postoperative neurocognitive dysfunction. Based on multiple logistic regression analysis, a neurocognitive deficit 4 to 6 wk after surgery was an independent predictor of a lower SF-36 physical component score (P = 0.004) and lower Lawton instrumental activities of daily living scale 6 mo postoperatively (P = 0.026). Treatment with 17beta-estradiol (P = 0.003) and smoking status (P = 0.015) were predictors of worse SF-36 mental health component rating. Preoperative lower scores were independently associated with low quality of life postoperatively for all measurements.
Postoperative neurocognitive dysfunction is associated with impaired quality of life in women after cardiac surgery. Perioperative treatment with 17beta-estradiol provides no benefits to postoperative quality of life. The relationship between low preoperative and postoperative self-rated health status suggests that some aspects of quality of life in postmenopausal women are not amenable to improvements with cardiac surgery.
女性在心脏手术后易发生神经并发症。我们之前报道过，围手术期使用神经保护剂类固醇17β-雌二醇对老年女性术后4至6周的神经认知终点并无改善作用。在本研究中，我们评估了心脏手术后绝经后女性早期术后神经认知功能障碍对生活质量的影响，以及围手术期17β-雌二醇治疗是否会对其产生影响。
174名绝经后女性在手术前一天开始以双盲方式随机接受17β-雌二醇或安慰剂治疗，持续至术后第五天。患者在手术前以及术后4至6周和6个月时使用标准测试组合进行心理测量测试。在基线和术后6个月时，使用SF-36问卷和Lawton日常生活工具活动量表评估生活质量。
108名女性有完整数据，其中13%表现出术后神经认知功能障碍。基于多因素逻辑回归分析，术后4至6周的神经认知缺陷是术后6个月时SF-36身体成分得分较低（P = 0.004）以及Lawton日常生活工具活动量表得分较低（P = 0.026）的独立预测因素。17β-雌二醇治疗（P = 0.003）和吸烟状况（P = 0.015）是SF-36心理健康成分评分较差的预测因素。术前较低的分数在所有测量中均与术后低生活质量独立相关。
术后神经认知功能障碍与心脏手术后女性的生活质量受损有关。围手术期使用17β-雌二醇对术后生活质量无益处。术前和术后自评健康状况较低之间的关系表明，绝经后女性生活质量的某些方面无法通过心脏手术得到改善。
