Maleva O V, Trubnikova O A, Syrova I D, Solodukhin A V, Golovin A A, Barbarash O L, Barbarash L S
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(3. Vyp. 2):5-12. doi: 10.17116/jnevro20201200325.
To evaluate the incidence of early postoperative cognitive dysfunction (POCD) after simultaneous carotid surgery and coronary artery bypass grafting (CABG) in patients with asymptomatic cerebral atherosclerosis.
Fifty-three patients with polyvascular disease and asymptomatic cerebral atherosclerosis undergoing simultaneous unilateral carotid endarterectomy (CEE) and CABG were recruited in the study. Core cognitive functions were assessed with the Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) at days 2-3 before the indexed surgery and at days 7-10 after it. All the patients were assigned to two groups based on the baseline MMSE score: one group with mild cognitive impairment (MCI) and another one without MCI. Neurodynamic measurements were performed using the Status-PF hardware-software complex (certificate #2001610233 of the Russian Agency for Patents and Trademarks), followed by the calculation of the integral indicator of the main cognitive domains according to the corresponding algorithms. Attention, memory and neurodynamics were evaluated in all participants. POCD was diagnosed with a decrease from the initial indicators of memory, attention and neurodynamics by 20% in 20% of the tests.
Patients had complications in the early postoperative period, regardless of the presence of MCI. A decline among the core cognitive functions was observed in both groups of patients at days 7-10 after the surgery. Patients demonstrated an increase in the reaction time while performing neurodynamic test battery compared with the baseline values. Alterations in memory and attention were not significant. Significant changes in the integral indicator of cognitive status were determined in both groups of patients. It increased by 14% in patients without MCI (0.34±0.2 in the preoperative period vs. 0.39±0.3 in the postoperative period, p=0.04), and by 36% in patients with MCI (0.25±0.19 vs. 0.39±0.3, p=0.003). Regardless of the presence or absence of MCI, all patients had low cognitive status or even that below the average in the perioperative period. Despite the increase in the average values of cognitive status indicators in the postoperative period, 56% of patients (n=14) without MCI and 71% of patients with MCI (n=20) had early POCD.
Patients with polyvascular disease, regardless of the presence of MCI, had low cognitive status or even that below the average, probably contributing to the elimination of the expected positive effects of CEE. The absence of MCI at baseline does not guarantee the preservation of cognitive status after surgery. Patients with polyvascular disease after myocardial and cerebral revascularization remain at high risk of exacerbating cognitive impairment, and, therefore, require an individual approach and a reasonable choice of the optimal surgical strategy.
评估无症状性脑动脉粥样硬化患者同期行颈动脉手术和冠状动脉旁路移植术（CABG）后早期术后认知功能障碍（POCD）的发生率。
本研究纳入了53例患有多血管疾病且无症状性脑动脉粥样硬化的患者，他们同期接受了单侧颈动脉内膜切除术（CEE）和CABG。在索引手术前2 - 3天以及术后7 - 10天，使用简易精神状态检查表（MMSE）和额叶评估量表（FAB）对核心认知功能进行评估。所有患者根据基线MMSE评分分为两组：一组为轻度认知障碍（MCI），另一组无MCI。使用Status - PF硬件 - 软件组合（俄罗斯专利和商标局证书编号2001610233）进行神经动力学测量，然后根据相应算法计算主要认知领域的综合指标。对所有参与者的注意力、记忆力和神经动力学进行评估。当记忆、注意力和神经动力学的初始指标在20%的测试中下降20%时，诊断为POCD。
无论是否存在MCI，患者在术后早期均出现并发症。两组患者在术后7 - 10天均观察到核心认知功能下降。与基线值相比，患者在进行神经动力学测试组合时反应时间增加。记忆力和注意力的改变不显著。两组患者认知状态综合指标均有显著变化。无MCI的患者该指标增加了14%（术前为0.34±0.2，术后为0.39±0.3，p = 0.04），有MCI的患者增加了36%（0.25±0.19 vs. 0.39±0.3，p = 0.003）。无论是否存在MCI，所有患者在围手术期认知状态均较低甚至低于平均水平。尽管术后认知状态指标的平均值有所增加，但56%（n = 14）无MCI的患者和71%（n = 20）有MCI的患者发生了早期POCD。
患有多血管疾病的患者，无论是否存在MCI，认知状态均较低甚至低于平均水平，这可能导致CEE预期的积极效果被抵消。基线时无MCI并不能保证术后认知状态得以保留。心肌和脑血管重建术后的多血管疾病患者仍有认知功能障碍加重的高风险，因此，需要个体化方法并合理选择最佳手术策略。
