Borowicz L M, Goldsborough M A, Selnes O A, McKhann G M
Zanvyl Krieger Mind/Brain Institute, Johns Hopkins University, Baltimore, MD, USA.
J Cardiothorac Vasc Anesth. 1996 Jan;10(1):105-11; quiz 111-2. doi: 10.1016/s1053-0770(96)80185-6.
Studies that have examined neuropsychologic change after cardiac surgery address three main issues: (1) the incidence of cognitive change; (2) the identification of factors that put patients at higher risk; and (3) the evaluation of interventions to prevent these complications. This review attempts to bring together concerns associated with various study designs and to integrate the conclusions from these studies. Thirty-five studies have been examined in this review. Some of the difficulties encountered when quantifying the degree of cognitive change are related to study design, patient sampling, and deficit definition. Additionally, changing patient populations have influenced results reported from different health care settings. Increasing age and longer cardiopulmonary bypass times have been correlated with cognitive decline in a number of studies. Filtration devices and blood gas management techniques have decreased but not eliminated the number of patients who have cognitive decline. Cognitive change exists following cardiac procedures. Identification of a subgroup of patients at high risk for cognitive change has been difficult, possibly due to issues of study design. Design of future studies, which may include intraoperative or pharmacologic interventions, is dependent on identification of this high-risk group.
（1）认知变化的发生率；（2）确定使患者处于更高风险的因素；（3）评估预防这些并发症的干预措施。本综述试图汇总与各种研究设计相关的问题，并整合这些研究的结论。本综述审查了35项研究。在量化认知变化程度时遇到的一些困难与研究设计、患者抽样和缺陷定义有关。此外，不断变化的患者群体影响了不同医疗环境报告的结果。在多项研究中，年龄增长和体外循环时间延长与认知能力下降相关。过滤装置和血气管理技术减少了但并未消除出现认知下降的患者数量。心脏手术后存在认知变化。很难确定认知变化高风险的患者亚组，这可能是由于研究设计问题。未来研究的设计，可能包括术中或药物干预，取决于对这个高风险组的识别。
