Holinski Sebastian, Claus Benjamin, Alaaraj Nour, Dohmen Pascal Maria, Neumann Konrad, Uebelhack Ralf, Konertz Wolfgang
Department of Cardiovascular Surgery, Charité Hospital, Medical University, Berlin, Germany.
Ann Thorac Cardiovasc Surg. 2011;17(2):137-42. doi: 10.5761/atcs.oa.10.01545.
Reduction of cognitive function is a possible side effect after the use of cardiopulmonary bypass (CPB) during cardiac surgery. Since it has been proven that piracetam is cerebroprotective in patients undergoing coronary bypass surgery, we investigated the effects of piracetam on the cognitive performance of patients undergoing open heart surgery.
Patients scheduled for elective open heart surgery were randomized to the piracetam or placebo group in a double-blind study. Patients received 12 g of piracetam or placebo at the beginning of the operation. Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer's Disease Assessment Scale were performed preoperatively and on day 3, postoperatively. To assess the overall cognitive function and the degree of cognitive decline across all tests after the surgery, we combined the six test-scores by principal component analysis.
A total of 88 patients with a mean age of 67 years were enrolled into the study. The mean duration of CPB was 110 minutes. Preoperative clinical parameters and overall cognitive functions were not significantly different between the groups. The postoperative combined score of the neuropsychological tests showed deterioration of cognitive function in both groups (piracetam: preoperative 0.19 ± 0.97 vs. postoperative -0.97 ± 1.38, p <0.0005 and placebo: preoperative -0.14 ± 0.98 vs. postoperative -1.35 ± 1.23, p <0.0005). Patients taking piracetam did not perform better than those taking placebo, and both groups had the same decline of overall cognitive function (p = 0.955).
Piracetam had no cerebroprotective effect in patients undergoing open heart surgery. Unlike the patients who underwent coronary surgery, piracetam did not reduce the early postoperative decline of neuropsychological abilities in heart valve patients.
心脏手术期间使用体外循环（CPB）后认知功能减退是一种可能的副作用。由于已证实吡拉西坦对接受冠状动脉搭桥手术的患者具有脑保护作用，我们研究了吡拉西坦对接受心脏直视手术患者认知表现的影响。
在一项双盲研究中，将计划进行择期心脏直视手术的患者随机分为吡拉西坦组或安慰剂组。患者在手术开始时接受12克吡拉西坦或安慰剂。术前及术后第3天进行了来自综合征简短测试和阿尔茨海默病评估量表的六项神经心理学子测试。为了评估手术后所有测试的整体认知功能和认知衰退程度，我们通过主成分分析将六个测试分数进行了合并。
共有88名平均年龄为67岁的患者纳入研究。CPB的平均持续时间为110分钟。两组术前临床参数和整体认知功能无显著差异。神经心理学测试的术后综合评分显示两组认知功能均有下降（吡拉西坦组：术前0.19±0.97 vs.术后-0.97±1.38，p<0.0005；安慰剂组：术前-0.14±0.98 vs.术后-1.35±1.23，p<0.
