BhaskerRao B, VanHimbergen D, Edmonds H L, Jaber S, Ali A T, Pagni S, Koenig S, Spence P A
Cardiovascular Research Center, Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
J Card Surg. 1998 Jan;13(1):27-31. doi: 10.1111/j.1540-8191.1998.tb01050.x.
Neurological impairment is a major cause of morbidity after cardiac surgery and may be associated with occurrence of cerebral microemboli generated during cardiopulmonary bypass (CPB). This study evaluates cerebral dysfunction following coronary artery surgery on-pump and off-pump.
Neurological outcome was evaluated in 322 patients with a coronary artery bypass graft (CABG). Conventional CPB was used (on-pump) in 305 patients and in 17 patients no CPB was used (off-pump). Intraoperatively, a pulsed-wave transcranial Doppler with a 2-MHZ probe measured high-intensity transient signals (HITS) by ultrasonic insonnation of the middle cerebral artery indicating the presence of emboli within the vessel lumen. Transcranial near-infrared spectroscopy measured cerebral venous oxygen saturation for adequate perfusion. Postoperatively, all patients were subjected to the antisaccadic eye movement (ASEM) test, a sensitive indicator of neurocognitive deficits secondary to frontal lobe dysfunction.
While there was no significant difference in O2 saturation, the number of microemboli HITS generated was significantly higher in the on-pump group than the off-pump group. In the off-pump group, 16 (94%) of 17 patients had perfect scores on the ASEM test, while only 108 (35.4%) of 305 patients achieved a perfect score in the on-pump group (p < 0.01). Furthermore, while all patients in the off-pump group achieved at least 90%, 28% (86/305) in the on-pump group scored "zero" on the ASEM test.
Cerebral dysfunction as evidenced by ASEM errors is common following coronary bypass on-pump, but rare with off-pump bypass surgery. Cerebral microemboli generated during CPB may account for this difference.
神经功能障碍是心脏手术后发病的主要原因，可能与体外循环（CPB）期间产生的脑微栓子的出现有关。本研究评估了冠状动脉搭桥手术中体外循环和非体外循环后的脑功能障碍。
对322例行冠状动脉搭桥术（CABG）的患者进行神经功能结局评估。305例患者采用传统体外循环（体外循环组），17例患者未采用体外循环（非体外循环组）。术中，使用2MHz探头的脉冲波经颅多普勒通过对大脑中动脉进行超声探测来测量高强度瞬态信号（HITS），以表明血管腔内存在栓子。经颅近红外光谱法测量脑静脉血氧饱和度以确保充足灌注。术后，所有患者均接受反扫视眼动（ASEM）测试，这是额叶功能障碍继发神经认知缺陷的敏感指标。
虽然血氧饱和度没有显著差异，但体外循环组产生的微栓子HITS数量显著高于非体外循环组。在非体外循环组中，17例患者中有16例（94%）在ASEM测试中获得满分，而在体外循环组中，305例患者中只有108例（35.4%）获得满分（p<0.01）。此外，虽然非体外循环组的所有患者至少达到了90%，但体外循环组中有28%（86/305）的患者在ASEM测试中得分为“零”。
体外循环冠状动脉搭桥术后，ASEM错误所证明的脑功能障碍很常见，但非体外循环搭桥手术中则很少见。CPB期间产生的脑微栓子可能是造成这种差异的原因。
