Treasure T, Smith P L, Newman S, Schneidau A, Joseph P, Ell P, Harrison M J
Middlesex Hospital, London, UK.
Eur J Cardiothorac Surg. 1989;3(3):216-21. doi: 10.1016/1010-7940(89)90069-9.
Patients undergoing routine coronary artery surgery (N = 76) were compared with those undergoing other major operations (N = 29) in a prospective multidisciplinary study designed to define the incidence of neurological and psychological sequelae. The preoperative state of the carotid and vertebral arteries was defined by digital subtraction angiography. Changes in clinical neurological examination, detailed neuropsychological testing, psychiatric assessment and cerebral blood flow were measured. All preoperative studies were repeated 8 days and 8 weeks after surgery. Clinical neurological examination was repeated in addition on the 1st postoperative day. New focal neurological signs were found in 8% of the cardiac patients and none of the comparison group 24 h after operation (P = 0.9). Global transient neurological dysfunction occurred in 59% of the coronary group in the 1st postoperative day compared with 21% in other forms of surgery (P = 0.0007) but this correlated with postoperative narcotic and sedative drugs. A deterioration in neuropsychological performance was detectable in 73% of coronary cases at 8 days which was more likely to occur with increasing age, longer bypass time and lower perfusion pressure, but similar neuropsychological changes also occurred in 50% of the comparison group. By 8 weeks, there was a significant improvement in the cardiac patients (37%, P less than 0.001) but not in the other group. Cerebral blood flow was reduced at 8 days in the coronary bypass patients but not in the comparison group suggesting that the mechanism of cerebral change may be different in the two groups.
在一项旨在确定神经和心理后遗症发生率的前瞻性多学科研究中，对接受常规冠状动脉手术的患者（N = 76）与接受其他大手术的患者（N = 29）进行了比较。通过数字减影血管造影术确定颈动脉和椎动脉的术前状态。测量临床神经学检查、详细神经心理学测试、精神病学评估和脑血流量的变化。所有术前研究在术后8天和8周重复进行。术后第1天还重复进行临床神经学检查。术后24小时，8%的心脏手术患者出现新的局灶性神经体征，而对照组无一例出现（P = 0.9）。术后第1天，59%的冠状动脉手术组患者出现全球短暂性神经功能障碍，而其他手术形式组为21%（P = 0.0007），但这与术后麻醉和镇静药物有关。8天时，73%的冠状动脉手术病例可检测到神经心理学表现恶化，年龄越大、体外循环时间越长和灌注压力越低越易发生，但对照组50%的患者也出现了类似的神经心理学变化。到8周时，心脏手术患者有显著改善（37%，P小于0.001），而另一组则没有。冠状动脉搭桥手术患者术后8天时脑血流量减少，而对照组未减少，这表明两组脑变化机制可能不同。
