Medvedeva L A, Zagorulko O I, Eremenko A A, Oystrakh A S, Drakina O V, Charchyan E R, Akselrod B A
Petrovsky Russian Research Center of Surgery, Moscow, Russia.
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(3):24-30. doi: 10.17116/jnevro202112103124.
To estimate the frequency of early postoperative neurological complications in patients undergoing planned surgery on the ascending aortic and arch of the aorta, and their long-term outcomes.
The prospective study included 100 patients who were operated on at the FSBSI Petrovsky Russian Research Center of Surgery. In group I (=50), operations were performed on the aortic arch with hypothermic circulatory arrest (26 °C) and antegrade cerebral perfusion. Patients in group II underwent prosthetics of the ascending aorta with extracorporeal circulation and moderate hypothermia (32 °C). All patients underwent monitoring of cerebral and tissue oxygenation, transcranial Doppler and testing of cognitive functions before and after surgery, and after 5 and 10 years of follow-up.
Postoperative stroke in group I was observed in 1 (2%) patient, no cases were observed in group II. Delirium was detected in 14% of patients in group I and 6% of patients in group II, its subsyndromal form was found in 6 and 4%, respectively. Moderate cognitive impairment in the immediate postoperative period was found in 42 and 26%; severe in 8% of group I. After 5 years of follow-up, the number of patients with moderate and severe cognitive impairment was 23.1 and 12.8%, respectively. After 10 years, severe disorders were identified in 37.5 and 21.9% of patients.
In cardiac surgery patients, intraoperative multimodal monitoring allows dynamic regulation of antegrade cerebral perfusion. Dynamic testing of cognitive functions and early detection of delirium in the immediate postoperative period improve long-term neurological treatment outcomes.
评估接受升主动脉和主动脉弓计划性手术患者术后早期神经并发症的发生率及其长期预后。
这项前瞻性研究纳入了100例在俄罗斯联邦国家预算外机构彼得罗夫斯基外科研究中心接受手术的患者。第一组（=50例）患者在主动脉弓手术时采用低温循环停止（26℃）和顺行性脑灌注。第二组患者在体外循环和中度低温（32℃）下进行升主动脉置换术。所有患者在手术前后、随访5年和10年后均接受脑和组织氧合监测、经颅多普勒检查及认知功能测试。
第一组有1例（2%）患者发生术后中风，第二组未观察到病例。第一组14%的患者和第二组6%的患者出现谵妄，其亚综合征形式分别在6%和4%的患者中发现。术后即刻中度认知障碍在第一组和第二组分别为42%和26%；第一组8%为重度认知障碍。随访5年后，中度和重度认知障碍患者的比例分别为23.1%和12.8%。10年后，分别有37.5%和21.9%的患者出现严重认知障碍。
在心脏手术患者中，术中多模式监测可实现顺行性脑灌注的动态调节。对认知功能进行动态测试并在术后即刻早期发现谵妄可改善长期神经治疗效果。
