Harrison M J
University College, London, United Kingdom.
Ann Thorac Surg. 1995 May;59(5):1356-8. doi: 10.1016/0003-4975(95)00056-q.
The central nervous system complications arising during or shortly after coronary artery bypass grafting are due to cerebral ischemia associated with hypotension and to embolism. Hemodynamic compromise produces a spectrum of disturbance of consciousness and mentation ranging from brain death and coma through the chronic vegetative state to mild confusion. Watershed infarction may add to this picture focal deficits such as visual disorientation and cortical field defects or bibrachial weakness (the "man in a barrel" syndrome). Macroembolism accounts for most perioperative strokes and is related to cardiac arrhythmias, to intracardiac thrombus, and particularly to the severity and friable nature of any aortic atheroma. Microembolism can cause focal problems in the watershed territory but is normally responsible for diffuse changes as seen in the neuropsychologic sequelae of coronary artery bypass grafting. Coexistent carotid artery disease rarely contributes to the postoperative neurologic changes.
冠状动脉旁路移植术期间或术后不久出现的中枢神经系统并发症，是由与低血压相关的脑缺血及栓塞所致。血流动力学障碍会引发一系列意识和精神状态紊乱，从脑死亡、昏迷到慢性植物状态，再到轻度意识模糊。分水岭梗死可能会在此基础上增加局灶性缺损，如视觉定向障碍、皮质视野缺损或双臂无力（“桶中人”综合征）。大多数围手术期卒中是由大栓子栓塞引起的，与心律失常、心内血栓有关，尤其与主动脉粥样硬化的严重程度及易碎性有关。微栓塞可在分水岭区域导致局灶性问题，但通常是冠状动脉旁路移植术神经心理学后遗症中所见弥漫性改变的原因。并存的颈动脉疾病很少导致术后神经功能变化。
