Christiansen Claus Behrend, Berg Ronan M G, Plovsing Ronni, Ronit Andreas, Holstein-Rathlou Niels-Henrik, Yndgaard Stig, Møller Kirsten
Centre of Inflammation and Metabolism, University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Intensive Care 4131, University Hospital Rigshospitalet, Copenhagen, Denmark.
Thorac Cardiovasc Surg. 2016 Oct;64(7):569-574. doi: 10.1055/s-0035-1566128. Epub 2015 Oct 26.
Cerebral hemodynamic disturbances in the peri- or postoperative period may contribute to postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). We therefore examined dynamic cerebral autoregulation (dCA) post-CPB and changes in neurocognitive function in patients that had undergone CABG. We assessed dCA by transfer function analysis of spontaneous oscillations between arterial blood pressure and middle cerebral artery blood flow velocity measured by transcranial Doppler ultrasound in eight patients 6 hours after the cessation of CPB; 10 healthy volunteers served as controls. Neurocognitive function was assessed by four specific tests 1 day prior to and 3 days after CPB. Even though patients exhibited systemic inflammation and anemic hypoxemia, dCA was similar to healthy volunteers (gain: 1.24 [0.94-1.49] vs. 1.22 [1.06-1.34] cm mm Hg s, = 0.97; phase: 0.33 [0.15-0.56] vs. 0.69 [0.50-0.77] rad, = 0.09). Neurocognitive testing showed a perioperative decline in the Letter Digit Coding Score ( = 0.04), while weaker dCA was associated with a lower Stroop Color Word Test (rho = - 0.90; = 0.01). We found no changes in dCA 6 hours after CPB. However, based on the data at hand, it cannot be ruled out that changes in dCA predispose to POCD, which calls for larger studies that assess the potential impact of dCA in the early postoperative period on POCD.
在接受体外循环（CPB）冠状动脉旁路移植术（CABG）的患者围手术期或术后，脑血流动力学紊乱可能导致术后认知功能障碍（POCD）。因此，我们研究了CPB后脑的动态自动调节（dCA）以及接受CABG患者的神经认知功能变化。我们通过对8例患者CPB停止6小时后经颅多普勒超声测量的动脉血压和大脑中动脉血流速度之间的自发振荡进行传递函数分析来评估dCA；10名健康志愿者作为对照。在CPB前1天和CPB后3天通过四项特定测试评估神经认知功能。尽管患者表现出全身炎症和贫血性低氧血症，但dCA与健康志愿者相似（增益：1.24[0.94 - 1.49]对1.22[1.06 - 1.34]cm·mmHg·s，P = 0.97；相位：0.33[0.15 - 0.56]对0.69[0.50 - 0.77]rad，P = 0.09）。神经认知测试显示围手术期字母数字编码得分下降（P = 0.04），而较弱的dCA与较低的斯特鲁普颜色词测试相关（rho = - 0.90；P = 0.01）。我们发现CPB后6小时dCA没有变化。然而，根据现有数据，不能排除dCA的变化易导致POCD，这需要更大规模的研究来评估术后早期dCA对POCD的潜在影响。
