Stump D A, Rogers A T, Hammon J W, Newman S P
Department of Anesthesia, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157, USA.
J Cardiothorac Vasc Anesth. 1996 Jan;10(1):113-8; quiz 118-9. doi: 10.1016/s1053-0770(96)80186-8.
There have been major advancements in cardiac surgery over the past two decades, with a concomitant decrease in mortality and major morbidity. However, several recent studies have demonstrated that cardiac surgery poses significant risk for negative neurologic and neuropsychologic outcome. Although very few patients die as a result of cardiac surgery, more than two thirds of the patients demonstrate evidence of neuropsychologic dysfunction postoperatively. The mechanisms contributing to post-cardiopulmonary bypass neuropsychologic deficits are uncertain. However, two major interrelated etiologic factors, hypoperfusion and emboli, are suggested as probable culprits. It is important to define the relationship between these two putative mechanisms and postoperative neuropsychologic outcome in order to either prevent the problem or treat the effects of emboli or hypoperfusion. For example, if embolism is the cause of the deficits, increasing cerebral perfusion would deliver more emboli and increase the amount of severity of injury. Conversely, if hypoperfusion is the cause of the injury, then decreasing brain blood flow would increase the likelihood of injury. If both are important, their relative significance must be established, then one prevented and the effects of the other treated. This report discusses the methodology for detecting cerebral emboli during cardiac surgery. The incidence and severity of neuropsychologic deficits after cardiac surgery are discussed, as well as emboli in relation to composition and time of occurrence and their effect on neuropsychologic outcome.
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。然而，最近的几项研究表明，心脏手术会给神经系统和神经心理方面带来显著的不良后果风险。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的迹象。体外循环后神经心理缺陷的发病机制尚不清楚。然而，两个主要的相互关联的病因因素，即灌注不足和栓子，被认为可能是罪魁祸首。明确这两种假定机制与术后神经心理结果之间的关系很重要，以便预防该问题或治疗栓子或灌注不足的影响。例如，如果栓塞是缺陷的原因，增加脑灌注会带来更多栓子并增加损伤的严重程度。相反，如果灌注不足是损伤的原因，那么减少脑血流量会增加损伤的可能性。如果两者都很重要，就必须确定它们的相对重要性，然后预防其中一个并治疗另一个的影响。本报告讨论了心脏手术期间检测脑栓子的方法。还讨论了心脏手术后神经心理缺陷的发生率和严重程度，以及栓子的组成、出现时间及其对神经心理结果的影响。
