微创冠状动脉旁路移植术后的神经学结局（NOMICS）：一项观察性前瞻性队列研究。
Neurological outcome after minimally invasive coronary artery bypass surgery (NOMICS): An observational prospective cohort study.
机构信息
Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium.
Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium.
出版信息
PLoS One. 2020 Dec 23;15(12):e0242519. doi: 10.1371/journal.pone.0242519. eCollection 2020.
BACKGROUND/OBJECTIVES: Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimally invasive CABG procedure with retrograde arterial perfusion. The main objective of this study is to assess neurocognitive outcome after Endo-CABG.
METHODS/DESIGN: In this prospective observational cohort study, patients were categorised into: Endo-CABG (n = 60), a comparative Percutaneous Coronary Intervention (PCI) group (n = 60) and a healthy volunteer group (n = 60). A clinical neurological examination was performed both pre- and postoperatively, delirium was assessed postoperatively. A battery of 6 neurocognitive tests, Quality of life (QoL) and the level of depressive feelings were measured at baseline and after 3 months. Patient Satisfaction after Endo-CABG was assessed at 3-month follow-up. Primary endpoints were incidence of postoperative cognitive dysfunction (POCD), stroke and delirium after Endo-CABG. Secondary endpoints were QOL, patient satisfaction and the incidence of depressive feelings after Endo-CABG.
RESULTS
In total, 1 patient after Endo-CABG (1.72%) and 1 patient after PCI (1.67%) suffered from stroke during the 3-month follow-up. POCD in a patient is defined as a Reliable Change Index ≤-1.645 or Z-score ≤-1.645 in at least two tests, and was found in respectively 5 and 6 patients 3 months after Endo-CABG and PCI. Total incidence of POCD/stroke was not different (PCI: n= 7 [15.9%]; Endo-CABG: n= 6 [13.0%], p = 0.732). ICU delirium after Endo-CABG was found in 5 (8.6%) patients. QoL increased significantly three months after Endo-CABG and was comparable with QoL level after PCI and in the control group. Patient satisfaction after Endo-CABG and PCI was comparable. At follow-up, the level of depressive feelings was decreased in all groups.
CONCLUSIONS
The incidence of poor neurocognitive outcome, including stroke, POCD and postoperative ICU delirium until three months after Endo-CABG is low and comparable with PCI.
TRIAL REGISTRATION
Registered on ClinicalTrials.gov (NCT02979782).
背景/目的：内镜冠状动脉旁路移植术（Endo-CABG）是一种微创的冠状动脉旁路移植术，具有逆行动脉灌注。本研究的主要目的是评估 Endo-CABG 后的神经认知结果。
方法/设计：在这项前瞻性观察队列研究中，患者分为：Endo-CABG（n=60）、经皮冠状动脉介入治疗（PCI）比较组（n=60）和健康志愿者组（n=60）。在术前和术后均进行临床神经检查，术后评估谵妄。在基线和 3 个月时测量 6 项神经认知测试、生活质量（QoL）和抑郁感水平。在 3 个月的随访中评估 Endo-CABG 后的患者满意度。主要终点是术后认知功能障碍（POCD）、Endo-CABG 后卒中的发生率和谵妄。次要终点是 Endo-CABG 后的 QoL、患者满意度和抑郁感发生率。
结果
在 3 个月的随访中，Endo-CABG 后 1 例（1.72%）和 PCI 后 1 例（1.67%）患者发生卒中。术后认知功能障碍患者定义为至少两项测试的可靠变化指数≤-1.645 或 Z 评分≤-1.645，Endo-CABG 和 PCI 后 3 个月分别发现 5 例和 6 例患者。POCD/卒中的总发生率无差异（PCI：n=7[15.9%]；Endo-CABG：n=6[13.0%]，p=0.732）。Endo-CABG 后 ICU 谵妄发生在 5 例（8.6%）患者中。Endo-CABG 后 3 个月 QoL 显著提高，与 PCI 和对照组的 QoL 水平相当。Endo-CABG 和 PCI 后的患者满意度相当。随访时，所有组的抑郁感水平均降低。
结论
Endo-CABG 后 3 个月内神经认知结局不良的发生率，包括卒中、POCD 和术后 ICU 谵妄，与 PCI 相似。
试验注册
ClinicalTrials.gov 注册（NCT02979782）。
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