Wimmer-Greinecker G, Matheis G, Brieden M, Dietrich M, Oremek G, Westphal K, Winkelmann B R, Moritz A
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
Thorac Cardiovasc Surg. 1998 Aug;46(4):207-12. doi: 10.1055/s-2007-1010226.
An alarming incidence (1% to 83%) of neuropsychological dysfunction has been reported after operations using cardiopulmonary bypass (CPB). The present clinical study re-evaluates these complications with current CPB technology in a strictly selected low-risk group of coronary artery bypass (CABG) patients.
76 CABG patients, without history of stroke or internal carotid artery stenosis, were examined before, 5 days after, and 2 months after surgery. A neuropsychological test battery was employed according to the "Statement of Consensus on Assessment of Neurobehavioral Outcomes after Cardiac Surgery". Tests include the Block Design Test (problem-solving strategies, recognition and analysis of forms), the Trail Making Test (cognitive achievement at speed), and the Digit Span Test (short-term memory and memory of figures).
Both postoperative test scores were not significantly decreased as compared to preoperative values. In contrast, neuron specific enolase (NSE) and S100 b protein, biochemical markers of cerebral injury, increased markedly during and immediately after surgery (NSE preop.: 7.07 +/- 2.40 ng/ml, 1 h postop.: 13.64 +/- 4.50 ng/ml, p < 0.001; S100 b preop.: 0.04 +/- 0.07 ng/ml, after crossclamp: 0.90 +/- 0.69 ng/ml, p < 0.001). One patient displayed postoperative transitional syndrome, another patient suffered from transitory paresis and hypesthesia of the left arm, which disappeared during hospital stay.
Biochemical markers demonstrate significant postoperative cerebral injury during and immediately after CPB. However, CPB for CABG does not lead to marked impairment of neuropsychological scores, and clinically relevant neurological findings were observed in one patient only.
据报道，使用体外循环（CPB）手术后神经心理功能障碍的发生率令人担忧（1%至83%）。本临床研究在经过严格筛选的低风险冠状动脉搭桥术（CABG）患者组中，采用当前的CPB技术对这些并发症进行了重新评估。
76例无中风或颈内动脉狭窄病史的CABG患者在手术前、术后5天和术后2个月接受检查。根据“心脏手术后神经行为结果评估共识声明”采用一套神经心理测试。测试包括积木设计测试（解决问题策略、形状识别和分析）、连线测试（速度方面的认知成就）和数字广度测试（短期记忆和数字记忆）。
与术前值相比，术后两项测试分数均未显著降低。相比之下，脑损伤的生化标志物神经元特异性烯醇化酶（NSE）和S100 b蛋白在手术期间和手术后立即显著升高（NSE术前：7.07±2.40 ng/ml，术后1小时：13.64±4.50 ng/ml，p<0.001；S100 b术前：0.04±0.07 ng/ml，主动脉阻断后：0.90±0.69 ng/ml，p<0.001）。一名患者出现术后过渡综合征，另一名患者出现左臂短暂性麻痹和感觉减退，住院期间消失。
生化标志物显示CPB期间及术后立即出现明显的脑损伤。然而，CABG的CPB不会导致神经心理评分明显受损，仅一名患者观察到具有临床相关性的神经学发现。
