Gottesman Rebecca F, McKhann Guy M, Hogue Charles W
Department of Neurology, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Semin Neurol. 2008 Nov;28(5):703-15. doi: 10.1055/s-0028-1105973. Epub 2008 Dec 29.
Neurological injury resulting from cardiac surgery has a range of manifestations from focal neurological deficit to encephalopathy or coma. As the safety of drug-eluting stents comes into question, more patients will likely undergo coronary artery bypass graft surgery. These projections, along with the growing proportions of elderly patients and those with comorbidities, portend the potential for rising rates of perioperative neurological complications. The risk for neurological injury may be determined by the type of procedure, by patient-specific characteristics, and by the extent of cerebral embolization and hypoperfusion during and after surgery. Changes in surgical techniques, including the use of off-pump surgery, have not decreased rates of brain injury from cardiac surgery. When appropriate, modern neuroimaging techniques should be used in postoperative patients to confirm diagnosis, to provide information on potential etiology, to direct appropriate therapy, and to help in prognostication. Management of postoperative medications and early use of rehabilitation services is a recommended strategy to optimize the recovery for individuals with neurological injury after cardiac surgery.
心脏手术导致的神经损伤有一系列表现，从局灶性神经功能缺损到脑病或昏迷。随着药物洗脱支架的安全性受到质疑，可能会有更多患者接受冠状动脉旁路移植手术。这些预测，再加上老年患者和合并症患者比例的不断增加，预示着围手术期神经并发症发生率可能上升。神经损伤的风险可能由手术类型、患者特定特征以及手术期间和术后脑栓塞和灌注不足的程度决定。手术技术的改变，包括使用非体外循环手术，并没有降低心脏手术导致脑损伤的发生率。在适当的时候，应在术后患者中使用现代神经影像学技术来确诊、提供潜在病因信息、指导适当治疗并帮助进行预后评估。术后药物管理和早期使用康复服务是优化心脏手术后神经损伤患者恢复的推荐策略。
