Omiya Hiroki, Yoshitani Kenji, Yamada Naoaki, Kubota Yosuke, Takahashi Kanae, Kobayashi Junjiro, Ohnishi Yoshihiko
Department of Anesthesiology, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
Can J Anaesth. 2015 Jun;62(6):595-602. doi: 10.1007/s12630-015-0327-x. Epub 2015 Feb 5.
Delirium after cardiac surgery is a serious complication, increasing morbidity and mortality. Despite its high expectations, off-pump coronary artery bypass grafting (OPCAB) has largely failed to reduce the incidence of postoperative neurological complications. To further investigate the reasons for this failure, we used perioperative brain magnetic resonance imaging (MRI) to determine the relation between MRI findings and postoperative delirium.
Altogether, 98 patients undergoing elective OPCAB were enrolled in this prospective observational study. Patients underwent brain MRI and magnetic resonance angiography (MRA) before and after surgery to identify cerebral infarction, white matter lesions, and intracranial artery stenosis. Postoperative delirium in the intensive care unit was measured using the delirium rating scale. The relation between postoperative delirium and MRI findings was examined using logistic regression.
Magnetic resonance imaging and MRA was completed in 88 (90%) of the patients. New ischemic lesions were present in seven (7.9%) patients. Delirium rating scale scores of 0, 1-7, and ≥ 8 were found in 25 (31%), 48 (60%), and seven (9%) patients, respectively. Multivariate logistic regression analysis revealed that new ischemic lesions (odds ratio [OR] 11.07, 95% confidence interval [CI]: 1.53 to 80.03; P = 0.017), carotid artery stenosis (OR 7.06, 95% CI: 1.59 to 31.13; P = 0.010), history of myocardial infarction (OR 3.78, 95% CI: 1.05 to 13.65; P = 0.043), and deep subcortical white matter hyperintensity (OR 3.04, 95% CI: 1.14 to 8.12; P = 0.027) were significantly associated with postoperative delirium.
Magnetic resonance imaging findings of new cerebral ischemic lesions, carotid stenosis, and deep subcortical white matter hyperintensity correlated significantly with postoperative delirium in patients who had undergone OPCAB surgery.
心脏手术后谵妄是一种严重并发症，会增加发病率和死亡率。尽管人们对非体外循环冠状动脉搭桥术（OPCAB）寄予厚望，但它在很大程度上未能降低术后神经并发症的发生率。为了进一步探究这种失败的原因，我们使用围手术期脑磁共振成像（MRI）来确定MRI结果与术后谵妄之间的关系。
共有98例行择期OPCAB的患者纳入了这项前瞻性观察研究。患者在手术前后接受脑MRI和磁共振血管造影（MRA）检查，以确定脑梗死、白质病变和颅内动脉狭窄情况。使用谵妄评定量表对重症监护病房中的术后谵妄进行测量。采用逻辑回归分析术后谵妄与MRI结果之间的关系。
88例（90%）患者完成了磁共振成像和MRA检查。7例（7.9%）患者出现了新的缺血性病变。谵妄评定量表评分为0、1 - 7和≥8的患者分别有25例（31%）、48例（60%）和7例（9%）。多因素逻辑回归分析显示，新的缺血性病变（比值比[OR] 11.07，95%置信区间[CI]：1.53至80.03；P = 0.017）、颈动脉狭窄（OR 7.06，95% CI：1.59至31.13；P = 0.010）、心肌梗死病史（OR 3.78，95% CI：1.05至13.65；P = 0.043）以及深部皮质下白质高信号（OR 3.04，95% CI：1.14至8.12；P = 0.027）与术后谵妄显著相关。
接受OPCAB手术患者的新脑缺血性病变、颈动脉狭窄和深部皮质下白质高信号的磁共振成像结果与术后谵妄显著相关。
