Vingerhoets G, Van Nooten G, Vermassen F, De Soete G, Jannes C
Department of Psychiatry and Neuropsychology, University Hospital Gent, Belgium.
Eur J Cardiothorac Surg. 1997 Mar;11(3):424-31. doi: 10.1016/s1010-7940(96)01031-7.
Cognitive dysfunction after extracorporeal circulation is a major continuing problem in modern cardiac surgery. We designed this prospective study to update the incidence of postoperative neuropsychological changes after routine cardiopulmonary bypass (CPB) and to identify perioperative variables associated with these complications.
We assessed the patients with a comprehensive neuropsychological test battery 1 day before, 7 days after (n = 109) and 6 months after (n = 91) cardiopulmonary bypass. We used patients undergoing major vascular or thoracic surgery as a surgical control group (n = 20).
Repeated measures multivariate analysis of variance (using surgical group as a between-subjects factor) on the group data revealed significant changes early after surgery compared with the preoperative performance (P = 0.001). The early changes are characterized by a significant decrease of visual attention and verbal memory performance (univariate F-tests, always P < 0.05). Cardiac patients showing cognitive impairment after cardiac surgery had lower preoperative ejection fractions (P = 0.014) and a more complicated medical history (P = 0.046). At 6-month follow-up, the patients performed significantly better than before surgery (P < 0.001). CPB patients showing persistent cognitive impairment at follow-up were significantly older at the time of surgery (P = 0.005). Individual comparisons revealed that 45% of the patients undergoing CPB showed evidence of cognitive impairment soon after surgery. In 12% of the patients, the cognitive sequelae persisted at follow-up. Both group data and individual incidence rates revealed neither significant pre-post differences between the surgical groups nor a time-by-group interaction effect. Variables directly associated with CPB were not significantly associated with the occurrence of cognitive impairment after surgery.
We conclude that an important proportion of the cognitive impairment after cardiac surgery is likely to be due to nonspecific effects of surgery.
体外循环后的认知功能障碍是现代心脏手术中一个主要的持续性问题。我们设计了这项前瞻性研究，以更新常规心肺转流术（CPB）后术后神经心理变化的发生率，并确定与这些并发症相关的围手术期变量。
我们在心肺转流术前1天、术后7天（n = 109）和术后6个月（n = 91），使用一套全面的神经心理测试组合对患者进行评估。我们将接受大血管或胸外科手术的患者作为手术对照组（n = 20）。
对组数据进行重复测量多变量方差分析（将手术组作为组间因素）显示，与术前表现相比，术后早期有显著变化（P = 0.001）。早期变化的特征是视觉注意力和言语记忆表现显著下降（单变量F检验，P始终< 0.05）。心脏手术后出现认知障碍的心脏患者术前射血分数较低（P = 0.014），病史更复杂（P = 0.046）。在6个月的随访中，患者的表现明显优于手术前（P < 0.001）。随访时仍有持续性认知障碍的CPB患者手术时年龄明显更大（P = 0.005）。个体比较显示，45%接受CPB的患者术后不久即有认知障碍的证据。12%的患者认知后遗症在随访时持续存在。组数据和个体发生率均显示手术组之间术前术后无显著差异，也没有时间×组交互效应。与CPB直接相关的变量与术后认知障碍的发生无显著关联。
我们得出结论，心脏手术后认知障碍的一个重要比例可能归因于手术的非特异性影响。
