Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy; Department of Anaesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy.
Br J Anaesth. 2022 Jan;128(1):11-25. doi: 10.1016/j.bja.2021.09.042. Epub 2021 Nov 30.
Postoperative cognitive decline occurs commonly after cardiac surgery. The available literature is inconclusive on the role of intraoperative causal or protective factors.
We systematically reviewed studies evaluating delayed neurocognitive recovery (DNR), postoperative neurocognitive disorder (NCD), stroke, and the mortality rates among patients undergoing hypothermic or normothermic cardiopulmonary bypass (CPB). We further performed a subgroup analysis for age, surgery type (coronary artery bypass grafting [CABG], valve surgery, or combined), and the mean arterial blood pressure (MAP) during CPB, and conducted a proportion meta-analysis after calculation of single proportions and confidence intervals (CIs).
We included a total of 58 studies with 9609 patients in our analysis. Among these, 1906 of 4010 patients (47.5%) had DNR, and 2071 of 7160 (28.9%) had postoperative NCD. Ninety of 4625 patients (2.0%) had a stroke, and 174 of 7589 (2.3%) died. There was no statistically significant relationship between the considered variables and DNR, NCD, stroke, and mortality. In the subgroup analysis comparing hypothermic with normothermic CPB, we found higher NCD rates after combined surgery; for normothermic CPB cases only, the rates of DNR and NCD were lower after combined surgery compared with CABG surgery. A MAP >70 mm Hg compared with MAP=50-70 mm Hg during CPB was associated with a lower rate of DNR.
Temperature, MAP during cardiopulmonary bypass age, and surgery type were not associated with neurocognitive disorders, stroke, and mortality in cardiac surgery. Normothermic cardiopulmonary bypass, particularly when performed with MAP >70 mm Hg, may reduce the risk of postoperative neurocognitive decline after cardiac surgery.
CRD42019140844.
心脏手术后常发生术后认知功能下降。关于术中因果或保护因素的作用，现有文献尚无定论。
我们系统地回顾了评估低温或常温体外循环（CPB）下患者延迟性神经认知恢复（DNR）、术后认知障碍（NCD）、中风和死亡率的研究。我们进一步针对年龄、手术类型（冠状动脉旁路移植术[CABG]、瓣膜手术或联合手术）和 CPB 期间的平均动脉压（MAP）进行了亚组分析，并在计算了单个比例和置信区间（CIs）后进行了比例荟萃分析。
我们共纳入了 58 项研究，共纳入了 9609 名患者。其中，4010 名患者中有 1906 名（47.5%）有 DNR，7160 名患者中有 2071 名（28.9%）有术后 NCD。4625 名患者中有 90 名（2.0%）发生中风，7589 名患者中有 174 名（2.3%）死亡。考虑到的变量与 DNR、NCD、中风和死亡率之间没有统计学上的显著关系。在比较低温与常温 CPB 的亚组分析中，我们发现联合手术的 NCD 发生率更高；仅在常温 CPB 情况下，与 CABG 手术相比，联合手术的 DNR 和 NCD 发生率较低。CPB 期间 MAP>70mmHg 与 MAP=50-70mmHg 相比，DNR 发生率较低。
在心脏手术中，体温、CPB 期间的 MAP、年龄和手术类型与神经认知障碍、中风和死亡率无关。常温 CPB，特别是在 MAP>70mmHg 时，可能会降低心脏手术后术后认知功能下降的风险。
PROSPERO 注册号：CRD42019140844。
