Sauvé M J, Doolittle N, Walker J A, Paul S M, Scheinman M M
Department of Physiologic Nursing, University of California, San Francisco, USA.
Am J Crit Care. 1996 Mar;5(2):127-39.
A range of neuro-cognitive sequelae, from mild intellectual impairments to brain death, have been reported in survivors of aborted sudden cardiac death.
To determine to what extent, if any, factors associated with cardiopulmonary resuscitation, left ventricular function, and mood state are related to outcomes in five cognitive areas, namely orientation, attention, memory, reasoning, and motor performance.
Repeated measures were used to assess cognitive outcomes in 45 sudden cardiac arrest survivors over the 6 months following cardiopulmonary resuscitation. A battery of neuro-psychological tests was used to assess cognitive outcomes and psychological status over time. The relationship of the cardiopulmonary resuscitation, left ventricular function, and psychological variables to cognitive outcomes were assessed at each data point. The independent variables included time to cardiopulmonary resuscitation, time to defibrillation, duration of cardiopulmonary resuscitation, time to awakening, ejection fraction, New York Heart Association Class I to IV, tension, anger, and depression.
During hospitalization 38 of the 45 survivors (84%) had mild to severe deficits in one or more cognitive areas; 19 of 38 survivors (50%) continued to be impaired in one or more cognitive areas at 6 months. Of these, all had mild to severe deficits in at least one aspect of memory, with delayed recall the most frequent impairment. Time to awakening accounted for a unique portion of the variance in orientation and memory outcomes over time. The left ventricular function variables accounted for a significant portion of the variance in motor speed.
Our results suggest that half of the long-term survivors of aborted sudden cardiac death are cognitively intact 6 months after resuscitation but that 25% have moderate to severe impairment in memory, which could hamper and/or preclude the resumption of prearrest roles.
在心脏性猝死复苏成功的幸存者中，已报告了一系列神经认知后遗症，从轻度智力障碍到脑死亡。
确定与心肺复苏、左心室功能和情绪状态相关的因素在多大程度上（如果有的话）与五个认知领域的结果相关，这五个认知领域即定向、注意力、记忆、推理和运动表现。
采用重复测量法评估45名心脏骤停幸存者在心肺复苏后6个月内的认知结果。使用一系列神经心理学测试来评估随时间变化的认知结果和心理状态。在每个数据点评估心肺复苏、左心室功能和心理变量与认知结果之间的关系。自变量包括心肺复苏时间、除颤时间、心肺复苏持续时间、苏醒时间、射血分数、纽约心脏协会心功能分级I至IV级、紧张、愤怒和抑郁。
在住院期间，45名幸存者中有38名（84%）在一个或多个认知领域存在轻度至重度缺陷；38名幸存者中有19名（50%）在6个月时仍在一个或多个认知领域存在缺陷。其中，所有人在记忆的至少一个方面都有轻度至重度缺陷，延迟回忆是最常见的损伤。苏醒时间在随时间变化的定向和记忆结果的方差中占独特部分。左心室功能变量在运动速度的方差中占很大一部分。
我们的结果表明，心脏性猝死复苏成功的长期幸存者中有一半在复苏后6个月认知功能完好，但25%的人在记忆方面有中度至重度损伤，这可能会妨碍和/或阻止恢复心脏骤停前的角色。
