Roach G W, Kanchuger M, Mangano C M, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham S H, Ley C
Kaiser Permanente Medical Center, San Francisco, CA, USA.
N Engl J Med. 1996 Dec 19;335(25):1857-63. doi: 10.1056/NEJM199612193352501.
Acute changes in cerebral function after elective coronary bypass surgery is a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of -- and the use of resources associated with -- perioperative adverse neurologic events, including cerebral injury.
In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures).
Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients with type I outcomes died, vs. 10 percent of those with type II and 2 percent of those with no adverse cerebral outcome; P<0.001 for all comparisons), longer hospitalization (25 days with type I outcomes, 21 days with type II, and 10 days with no adverse outcome; P<0.001), and a higher rate of discharge to facilities for intermediate- or long-term care (69 percent, 39 percent, and 10 percent ; P<0.001). Predictors of type I outcomes were proximal aortic atherosclerosis, a history of neurologic disease, and older age; predictors of type II outcomes were older age, systolic hypertension on admission, pulmonary disease, and excessive consumption of alcohol.
Adverse cerebral outcomes after coronary bypass surgery are relatively common and serious; they are associated with substantial increases in mortality, length of hospitalization, and use of intermediate- or long-term care facilities. New diagnostic and therapeutic strategies must be developed to lessen such injury.
择期冠状动脉搭桥手术后脑功能的急性变化是一个棘手的临床问题。我们开展了一项多中心研究，以确定围手术期不良神经事件（包括脑损伤）的发生率、预测因素以及与之相关的资源使用情况。
在一项前瞻性研究中，我们评估了来自美国24家机构的2108例患者的两种一般类型的神经学结局：I型（局灶性损伤，或出院时昏迷或昏睡）和II型（智力功能减退、记忆缺陷或癫痫发作）。
129例患者（6.1%）出现不良脑结局。共有3.1%的患者出现I型神经学结局（8例死于脑损伤，55例发生非致命性卒中，2例发生短暂性脑缺血发作，1例昏睡），3.0%的患者出现II型结局（55例智力功能减退，8例癫痫发作）。出现不良脑结局的患者院内死亡率更高（I型结局患者中有21%死亡，II型患者为10%，无不良脑结局患者为2%；所有比较P<0.001），住院时间更长（I型结局患者为25天，II型为21天，无不良结局患者为10天；P<0.001），转至中长期护理机构的出院率更高（分别为69%、39%和10%；P<0.001）。I型结局的预测因素为升主动脉粥样硬化、神经疾病史和高龄；II型结局的预测因素为高龄、入院时收缩期高血压、肺部疾病和过量饮酒。
冠状动脉搭桥手术后的不良脑结局相对常见且严重；它们与死亡率、住院时间以及中长期护理机构的使用大幅增加相关。必须制定新的诊断和治疗策略以减轻此类损伤。
