Otomo Sumi, Maekawa Kengo, Goto Tomoko, Baba Tomoko, Yoshitake Atsushi
Department of Anesthesiology, Kumamoto Chuo Hospital, Minami-ku, Kumamoto, Japan.
Interact Cardiovasc Thorac Surg. 2013 Nov;17(5):799-804. doi: 10.1093/icvts/ivt304. Epub 2013 Jul 12.
Delirium is a common and critical clinical syndrome in older patients. We examined whether abnormalities in the brain that could be assessed by magnetic resonance imaging predisposed patients to develop delirium after coronary artery bypass graft surgery. We also analysed the association between delirium and cognitive dysfunction after coronary artery bypass graft surgery.
Data were collected prospectively on 153 patients aged 60 years or older who consecutively underwent elective isolated coronary artery bypass graft surgery. All patients were assessed for prior cerebral infarctions and craniocervical artery stenosis by magnetic resonance imaging (MRI) and angiography of their brains. Atherosclerosis of the ascending aorta was examined by epiaortic ultrasound at the time of surgery. Individual cognitive status was measured using four tests in all the patients before surgery and on the seventh postoperative day. A single psychiatrist diagnosed delirium using the Diagnostic and Statistical Manual of Mental Disorders 4th edition IV criteria.
Postoperative delirium occurred in 16 patients (10.5%). Compared with patients who did not develop postoperative delirium, delirious patients had significantly higher rates of peripheral artery disease, preoperative decline in global cognitive function and pre-existing multiple cerebral infarctions on MRI. In addition, 9 (56%) of the delirious patients suffered postoperative cognitive dysfunction. Stepwise logistic regression analysis found significant independent predictors of postoperative delirium to be preoperative cerebral infarcts on MRI (odds ratio [OR], 2.26; 95% confidence interval [CI] 1.10-4.78), preoperative decline in global cognitive function (OR 4.54; 95% CI 1.21-16.51) and atherosclerosis of the ascending aorta (OR 2.44; 95% CI 1.03-5.62).
Our findings suggested that postoperative delirium was associated with pre-existing multiple cerebral infarctions on MRI, preoperative decline in global cognitive function and ascending aortic atherosclerosis in elderly patients undergoing coronary artery bypass graft surgery and increased risk of postoperative cognitive dysfunction.
谵妄是老年患者常见且严重的临床综合征。我们研究了磁共振成像可评估的脑部异常是否会使患者在冠状动脉搭桥手术后易发生谵妄。我们还分析了冠状动脉搭桥手术后谵妄与认知功能障碍之间的关联。
前瞻性收集了153例60岁及以上连续接受择期单纯冠状动脉搭桥手术患者的数据。所有患者均通过脑部磁共振成像（MRI）和血管造影评估既往脑梗死和颅颈动脉狭窄情况。手术时通过主动脉超声检查升主动脉粥样硬化情况。在所有患者术前及术后第7天使用四项测试测量个体认知状态。一名精神科医生使用《精神障碍诊断与统计手册》第4版（DSM-IV）标准诊断谵妄。
16例患者（10.5%）发生术后谵妄。与未发生术后谵妄的患者相比，谵妄患者外周动脉疾病发生率、术前整体认知功能下降率以及MRI上已存在的多发性脑梗死发生率显著更高。此外，9例（56%）谵妄患者出现术后认知功能障碍。逐步逻辑回归分析发现，术后谵妄的显著独立预测因素为MRI上的术前脑梗死（比值比[OR]，2.26；95%置信区间[CI] 1.10 - 4.78）、术前整体认知功能下降（OR 4.54；95% CI 1.21 - 16.51）和升主动脉粥样硬化（OR 2.44；95% CI 1.03 - 5.62）。
我们的研究结果表明，在接受冠状动脉搭桥手术的老年患者中，术后谵妄与MRI上已存在的多发性脑梗死、术前整体认知功能下降和升主动脉粥样硬化相关，且术后认知功能障碍风险增加。
