Jovin Daniel G, Katlaps Karl G, Ellis Ben K, Dharmaraj Benita
Cardiothoracic Research, Department of Surgery, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA.
Interv Med Appl Sci. 2019 Mar;11(1):27-37. doi: 10.1556/1646.11.2019.01.
Cerebral ischemia in the perioperative period is a major risk factor for stroke, encephalopathy, and cognitive decline after cardiothoracic surgery. After coronary artery bypass grafting, both stroke and encephalopathy can result in poor patient outcomes and increased mortality. Neuroprotection aims to lessen the severity and occurrence of further injury mediated by stroke and encephalopathy and to aid the recovery of conditions already present. Several pharmacological and non-pharmacological methods of neuroprotection have been investigated in experimental studies and in animal models, and, although some have shown effectiveness in protection of the central nervous system, for most, clinical research is lacking or did not show the expected results. This review summarizes the value and need for neuroprotection in the context of cardiothoracic surgery and examines the use and effectiveness of several agents and methods with an emphasis on clinical trials and clinically relevant neuroprotectants.
围手术期脑缺血是心胸外科手术后发生中风、脑病和认知功能下降的主要危险因素。冠状动脉搭桥术后，中风和脑病均会导致患者预后不良和死亡率增加。神经保护旨在减轻由中风和脑病介导的进一步损伤的严重程度和发生率，并促进已存在病症的恢复。在实验研究和动物模型中，已经对几种神经保护的药理学和非药理学方法进行了研究，尽管有些方法已显示出对中枢神经系统的保护作用，但大多数方法缺乏临床研究或未显示出预期结果。本综述总结了心胸外科手术中神经保护的价值和必要性，并重点结合临床试验和临床相关神经保护剂，探讨了几种药物和方法的应用及有效性。
