Ganguly Gautam, Dixit Vikas, Patrikar Seema, Venkatraman Ravishankar, Gorthi Satya Prakash, Tiwari Nikhil
Department of Cardiothoracic and Vascular Surgery, Armed Forces Medical College, Pune, India
Department of Cardiothoracic and Vascular Surgery, Armed Forces Medical College, Pune, India.
Asian Cardiovasc Thorac Ann. 2015 Sep;23(7):774-80. doi: 10.1177/0218492315583562. Epub 2015 May 4.
Neurocognitive dysfunction continues to be the bane of open heart surgery despite vast improvements in surgical, anesthetic, and postoperative management. This observational cohort study was carried out to evaluate the efficacy of intraoperative CO2 insufflation by the field flooding technique in reducing postoperative neurocognitive dysfunction.
Three hundred randomly selected patients undergoing open heart surgery were observed: 150 (group A) were exposed to CO2 insufflation, and the other 150 (group B) were not exposed to CO2. Anesthetic, cardiopulmonary bypass, and myocardial protection techniques were standardized and similar in both groups. Neurocognitive function tests were performed preoperatively, 1 week postoperatively, and after 1 month.
The analysis revealed that neurocognitive dysfunction occurred in 8 of 150 patients in group A (incidence p1 = 0.053) and 27 of 150 in group B (incidence p2 = 0.18). The relative risk of neurocognitive dysfunction was 0.30 (p = 0.001, 95% confidence interval 0.14-0.63), implying that CO2 insufflation is protective against neurocognitive dysfunction. The risk difference was 0.13 (p2-p1); this implies that 13% of patients can be prevented from developing neurocognitive dysfunction if exposed to CO2.
This study confirms the known advantage of the relatively underutilized practice of CO2 insufflation. We recommend that CO2 insufflation be performed in all open heart surgery cases to bring down the incidence of neurocognitive dysfunction. This technique is simple to use without any major paraphernalia or additional cost.
尽管在手术、麻醉及术后管理方面有了巨大改进，但神经认知功能障碍仍是心脏直视手术的一大难题。本观察性队列研究旨在评估术中采用术野灌注技术进行二氧化碳充气在降低术后神经认知功能障碍方面的疗效。
观察300例随机选取的接受心脏直视手术的患者：150例（A组）接受二氧化碳充气，另外150例（B组）未接受二氧化碳充气。两组的麻醉、体外循环及心肌保护技术均标准化且相似。术前、术后1周及1个月进行神经认知功能测试。
分析显示，A组150例患者中有8例发生神经认知功能障碍（发生率p1 = 0.053），B组150例中有27例发生（发生率p2 = 0.18）。神经认知功能障碍的相对风险为0.30（p = 0.001，95%置信区间0.14 - 0.63），这意味着二氧化碳充气对神经认知功能障碍具有保护作用。风险差异为0.13（p2 - p1）；这意味着如果暴露于二氧化碳，13%的患者可预防发生神经认知功能障碍。
本研究证实了二氧化碳充气这种相对未充分利用的做法的已知优势。我们建议在所有心脏直视手术病例中进行二氧化碳充气，以降低神经认知功能障碍的发生率。该技术使用简单，无需任何大型设备或额外费用。
