Aberg T, Ronquist G, Tydén H, Brunnkvist S, Bergström K
Scand J Thorac Cardiovasc Surg. 1987;21(2):159-63. doi: 10.3109/14017438709106515.
The incidence and extent of cerebral damage following open-heart surgery were prospectively investigated in 103 patients, using clinical assessment, psychometry, adenylate kinase analysis in cerebrospinal fluid (CSF-AK) and computed tomography (CT) of the brain. The surgical mortality was 1.9%. Clinically there was obvious cerebral dysfunction in four cases, subtle evidence of brain damage (mainly undue fatigue) in 16 and no evidence in 81 cases. In the 16 patients the mean CSF-AK was substantially increased (0.122 U/l) and the psychometric performance distinctly impaired (-12 points) postoperatively; in the 81 patients the figures were 0.55 U/l and -3.4. Psychometrically, 60% of the patients showed cerebral dysfunction, which was pronounced in 16%. CSF-AK analysis indicated cerebral damage as absent or trival in 45%, moderate in 33% and marked in 22%. CT revealed postoperative cerebral infarction in two cases. Results from the various methods showed reasonable correlation, but also considerable overlap. Open-heart surgery thus can cause brain damage additional to that neurologically discernible. Fatigue is an important sign in this context. In research on postoperative brain damage, the relative insensitivity of routine neurologic investigation calls for supplementary, refined methods.
采用临床评估、心理测试、脑脊液腺苷酸激酶分析（CSF-AK）和脑部计算机断层扫描（CT），对103例心脏直视手术后脑损伤的发生率和程度进行了前瞻性研究。手术死亡率为1.9%。临床上，4例有明显的脑功能障碍，16例有轻微脑损伤证据（主要是过度疲劳），81例无证据。16例患者术后脑脊液腺苷酸激酶平均大幅升高（0.122 U/l），心理测试表现明显受损（-12分）；81例患者的相应数值分别为0.55 U/l和-3.4。心理测试显示，60%的患者存在脑功能障碍，其中16%表现明显。脑脊液腺苷酸激酶分析表明，45%的患者无或仅有轻微脑损伤，33%为中度损伤，22%为重度损伤。CT显示2例术后脑梗死。各种方法的结果显示出合理的相关性，但也有相当大的重叠。因此，心脏直视手术除了造成神经学上可察觉的脑损伤外，还可导致其他脑损伤。在这种情况下，疲劳是一个重要迹象。在术后脑损伤的研究中，常规神经学检查的相对不敏感性需要补充更精细的方法。
