Stump D A
Department of Anesthesia, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1009, USA.
Ann Thorac Surg. 1995 May;59(5):1340-4. doi: 10.1016/0003-4975(95)00108-w.
There have been major advancements in cardiac surgery over the past two decades and a concomitant decrease in mortality and major morbidity. The improved safety in cardiac procedures permitted 330,000 operations involving cardiopulmonary bypass in 1992. However, several recent studies have demonstrated that cardiac surgery poses substantial risk of negative neurologic and neuropsychologic outcomes. Although very few patients die as a result of a cardiac operation, more than two thirds of patients demonstrate evidence of neuropsychologic dysfunction postoperatively. The mechanisms contributing to neuropsychologic deficits after cardiopulmonary by-pass are uncertain. To characterize the incidence and severity of such deficits after cardiac operations, a concise battery of neuropsychologic tests that provides reliable evidence of subtle brain trauma is essential. With an objective, valid measure of brain injury, the etiology of neuropsychologic deficits can be identified and either eliminated or the effects ameliorated. The proper selection and use of neurobehavioral tools provides a basis to evaluate the efficacy of surgical and pharmacologic interventions to further improve neurologic outcome after cardiopulmonary bypass.
在过去二十年中，心脏外科手术取得了重大进展，死亡率和主要并发症发生率随之下降。1992年，心脏手术安全性的提高使得33万例涉及体外循环的手术得以进行。然而，最近的几项研究表明，心脏手术会带来严重的神经和神经心理负面结果风险。虽然因心脏手术死亡的患者极少，但超过三分之二的患者术后出现神经心理功能障碍迹象。体外循环后导致神经心理缺陷的机制尚不清楚。为了明确心脏手术后此类缺陷的发生率和严重程度，一套简洁的神经心理测试至关重要，它能提供轻微脑损伤的可靠证据。通过客观、有效的脑损伤测量方法，可以确定神经心理缺陷的病因，并将其消除或减轻影响。正确选择和使用神经行为工具为评估手术和药物干预的疗效提供了基础，以进一步改善体外循环后的神经结局。
