Department of Cardiology, Washington Hospital Center, Washington, DC, USA.
J Am Coll Cardiol. 2012 Aug 28;60(9):791-7. doi: 10.1016/j.jacc.2012.02.079.
The appearance of cognitive dysfunction after cardiac surgery in the absence of focal neurologic signs, a poorly understood but potentially devastating complication, almost certainly results from procedure-related brain injury. Confirmation of the occurrence of perioperative silent brain injury has been developed through advances in magnetic resonance imaging (MRI) techniques. These techniques detect new brain lesions in 25% to 50% of patients after both coronary artery bypass graft and valve surgery. Use of post-operative cognitive dysfunction as a marker of brain injury is problematic because of potential difficulties in ascertainment. It can be hypothesized that post-operative appearance of MRI lesions may serve as a more objective marker of brain injury in research efforts. If MRI examination can be used in this way, then 2 vitally important questions can be addressed. 1) What is the frequency of important, but silent, brain injury during cardiac surgery? 2) Does long-term cognitive impairment ensue? This review briefly discusses clinical features of post-operative cognitive dysfunction and reviews the evidence supporting a possible association with MRI evidence of perioperative brain injury and its potential for long-term dementia. We conclude that this association is plausible, but not yet firmly established.
心脏手术后出现认知功能障碍而没有局灶性神经体征，这是一种理解不深但潜在破坏性很强的并发症，几乎肯定是由于与手术相关的脑损伤所致。通过磁共振成像 (MRI) 技术的进步，已经可以确认围手术期无声脑损伤的发生。这些技术在冠状动脉旁路移植术和瓣膜手术后的 25% 至 50%的患者中检测到新的脑部病变。由于在确定方面存在潜在的困难，将术后认知功能障碍作为脑损伤的标志物存在问题。可以假设，术后 MRI 病变的出现可能是研究中脑损伤更客观的标志物。如果可以以这种方式使用 MRI 检查，则可以解决两个非常重要的问题。1）心脏手术期间是否存在重要但无声的脑损伤？2）是否会导致长期认知障碍？本综述简要讨论了术后认知功能障碍的临床特征，并回顾了支持与围手术期脑损伤的 MRI 证据存在关联及其导致长期痴呆的潜在可能性的证据。我们的结论是，这种关联是合理的，但尚未得到确凿证实。
