McKhann G M, Goldsborough M A, Borowicz L M, Selnes O A, Mellits E D, Enger C, Quaskey S A, Baumgartner W A, Cameron D E, Stuart R S, Gardner T J
Zanvyl Krieger Mind/Brain Institute, Johns Hopkins University, Baltimore, Maryland, USA.
Ann Thorac Surg. 1997 Feb;63(2):510-5. doi: 10.1016/s0003-4975(96)01057-0.
Cognitive deficits have been reported in patients after coronary artery bypass grafting, but the incidence of these deficits varies widely. We studied prospectively the incidence of cognitive change and whether the changes persisted over time.
Cognitive testing was done preoperatively and 1 month and 1 year postoperatively in 127 patients undergoing coronary artery bypass grafting. Tests were grouped into eight cognitive domains. A change of 0.5 standard deviation or more at 1 month and 1 year from patient's preoperative Z score was the outcome measure.
We identified four main outcomes for each cognitive domain: no decline; decline and improvement; persistent decline; and late decline. Only 12% of patients showed no decline across all domains tested; 82% to 90% of patients had no decline in visual memory, psychomotor speed, motor speed, and executive function; 21% and 26% had decline and improvement in verbal memory and language; approximately 10% had persistent decline in the domains of verbal memory, visual memory, attention, and visuoconstruction; and 24% had late decline (between 1 month and 1 year) in visuoconstruction.
This study establishes that the incidence of cognitive decline varies according to the cognitive domain studied and that some patients have persistent and late cognitive changes in specific domains after coronary artery bypass grafting.
已有报道称冠状动脉搭桥术后患者存在认知缺陷，但这些缺陷的发生率差异很大。我们前瞻性地研究了认知变化的发生率以及这些变化是否随时间持续存在。
对127例行冠状动脉搭桥术的患者在术前、术后1个月和1年进行认知测试。测试分为八个认知领域。以患者术前Z评分在1个月和1年时变化0.5个标准差或更多作为观察指标。
我们确定了每个认知领域的四种主要结果：无下降；下降并改善；持续下降；以及后期下降。在所有测试领域中，只有12%的患者无下降；82%至90%的患者在视觉记忆、心理运动速度、运动速度和执行功能方面无下降；21%和26%的患者在言语记忆和语言方面下降并改善；约10%的患者在言语记忆、视觉记忆、注意力和视空间构建领域持续下降；24%的患者在视空间构建方面出现后期下降（在1个月至1年之间）。
本研究表明，认知下降的发生率因所研究的认知领域而异，并且一些患者在冠状动脉搭桥术后特定领域存在持续和后期的认知变化。
