Hammon John W
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
J Extra Corpor Technol. 2013 Jun;45(2):116-21.
Brain injury during cardiac surgery can cause a potentially disabling syndrome consisting mainly of cognitive dysfunction but can manifest itself as symptoms and signs indistinguishable from frank stroke. The cause of the damage is mainly the result of emboli consisting of solid material such as clots or atherosclerotic plaque, fat, and/or gas. These emboli enter the cerebral circulation from the cardiopulmonary bypass machine, break off the aorta during manipulation, and enter the circulation from cardiac chambers. This damage can be prevented or at least minimized by avoiding aortic manipulation, filtering aortic inflow from the pump, preventing air from entering the pump plus careful deairing of the heart. Shed blood from the cardiotomy suction should be processed by a cell saver whenever possible. By doing these maneuvers, inflammation of the brain can be avoided. Long-term neurocognitive damage has been largely prevented in large series of patients having high-risk surgery, which makes these preventive measures worthwhile.
心脏手术期间的脑损伤可导致一种潜在致残综合征，主要表现为认知功能障碍，但也可能表现出与明显中风难以区分的症状和体征。损伤的原因主要是由固体物质如血栓或动脉粥样硬化斑块、脂肪和/或气体组成的栓子所致。这些栓子从体外循环机进入脑循环，在手术操作期间从主动脉脱落，并从心腔进入循环。通过避免主动脉操作、过滤来自泵的主动脉血流、防止空气进入泵以及仔细排除心脏内的空气，这种损伤可以得到预防或至少降至最低。只要有可能，心脏切开术吸引出的失血应通过血液回收机进行处理。通过采取这些措施，可以避免脑部炎症。在接受高风险手术的大量患者中，长期神经认知损伤已在很大程度上得到预防，这使得这些预防措施很有价值。
