Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
Ann Thorac Surg. 2010 Apr;89(4):1091-7. doi: 10.1016/j.athoracsur.2009.11.056.
The relationship of aortic atheroma to postoperative cognitive dysfunction (POCD), a common complication of coronary artery bypass graft surgery, has not been resolved. We undertook assessment of aortic atheroma using intraoperative ultrasonography and related the degree of aortic atheroma to POCD.
Aortic atheroma was assessed using intraoperative transesophageal and epiaortic echocardiography in 311 patients who underwent coronary artery bypass graft surgery. Atheroma was graded from 0 (normal or minimal) to 3 (mobile or rough) in each of four quadrants of the proximal ascending to proximal descending thoracic aorta. Atheroma burden was defined as the atheroma score divided by the total possible score for that patient. Patients also completed a neuropsychological battery consisting of eight tests taken the week before surgery and at 1 week and 3 and 12 months afterward. Decreased cognitive function for each test was defined as an individual decrease of at least 1 standard deviation of the group baseline mean for that test, and POCD was defined as a decrease in two or more tests.
The atheroma burden (%) was greater in the patients with POCD. The difference was greatest at 1 week (10.4+/-14.7 versus 4.4+/-9.0, p=0.0002) and diminished progressively at 3 months (8.9+/-14.1 versus 5.4+/-10.1, p=0.06) and 12 months (6.6+/-12.0 versus 5.6+/-10.2, p=0.56). Multivariable analysis showed that atheroma burden strongly predicted POCD at 1 week.
Aortic atheroma burden predicts POCD at 1 week but has less impact on POCD as time progresses. Atheroma burden is highly correlated with age and may be a good predictor of early POCD.
主动脉粥样硬化与术后认知功能障碍（POCD）有关，POCD 是冠状动脉旁路移植术的常见并发症，但二者之间的关系尚未明确。我们通过术中超声评估主动脉粥样硬化情况，并将主动脉粥样硬化程度与 POCD 相关联。
311 例行冠状动脉旁路移植术的患者术中接受经食管和主动脉外膜超声心动图评估主动脉粥样硬化。将升主动脉近端至降主动脉近端的四个象限的主动脉粥样硬化程度从 0（正常或轻微）到 3（移动或粗糙）进行分级。粥样斑块负担定义为患者的粥样斑块评分除以该患者的总可能评分。患者还在术前一周、术后 1 周、3 个月和 12 个月完成了包含八项测试的神经心理学测试。每个测试的认知功能下降定义为该测试组基线平均值至少下降 1 个标准差，POCD 定义为两个或多个测试下降。
POCD 患者的粥样斑块负担（%）更高。差异在术后 1 周时最大（10.4+/-14.7 比 4.4+/-9.0，p=0.0002），术后 3 个月（8.9+/-14.1 比 5.4+/-10.1，p=0.06）和 12 个月（6.6+/-12.0 比 5.6+/-10.2，p=0.56）时逐渐减少。多变量分析显示，粥样斑块负担在术后 1 周时强烈预测 POCD。
主动脉粥样硬化负担可预测术后 1 周时的 POCD，但随着时间的推移，对 POCD 的影响较小。粥样斑块负担与年龄高度相关，可能是早期 POCD 的良好预测指标。
