The Effects of Cardiopulmonary Bypass on the Number of Cerebral Microemboli and the Incidence of Cognitive Dysfunction After Coronary Artery Bypass Graft Srugery
BACKGROUND: Postoperative cognitive dysfunction (POCD) can be a debilitating complication after coronary artery bypass graft (CABG) surgery. Cerebral microemboli during cardiopulmonary bypass (CPB) are believed to be an important etiologic factor of POCD. In this study, we examined whether avoidance of CPB with ”off-pump” surgery reduces the number of cerebral microemboli and the incidence of POCD after CABG surgery in Chinese population. METHODS: Two hundred twenty-seven patients were enrolled in this prospective cohort study. Fifty-nine patients underwent CABG surgery with CPB and 168 underwent off-pump surgery. Cerebral microemboli were measured continuously with bilateral transcranial Doppler ultrasonography of the middle cerebral arteries. A neuropsychological test battery that included seven tests with nine subscales was administered at baseline, as well as at 1 wk and 3 mo after surgery. POCD was defined using the international study of POCD1 definition. RESULTS: The median total number of cerebral microemboli for the case was 430 (range: 155-2088) in patients undergoing surgery with CPB and 2 (0-66) in the off-pump patients (P < 0.001). There were no differences in the incidence of POCD between the patients having surgery with or without CPB either at 1 wk (55.2％ or 32 of 58 patients ”95% confidence interval: 41.5%-68.3%” vs 47.0% or 78 of 166 patients ”39.2%-54.9%”, P = 0.283) or 3 mo (6.4% or 3 of 47 patients ”1.3%-17.5%” vs 13.1% or 16 of 122 of patients ”7.7%-20.4%”, P = 0.214) after surgery. Increasing age and shorter duration of postoperative hospital stay were independently associated with cognitive dysfunction at 1 wk after surgery. Increasing age and a history of diabetes mellitus were independently associated with cognitive dysfunction 3 mo after surgery. CPB or cerebral microemboli were not significantly related to the occurrence of POCD. CONCLUSIONS: In Chinese population, avoidance of CPB during CABG surgery significantly decreased the number of cerebral microemboli, but it did not decrease the incidence of POCD at either 1 wk or 3 mo after CABG. Neither CPB nor cerebral microemboli was independently associated with the risk of POCD.
Ying-Hua Liu Yi-Ning Huang Wei Sun Dong-Xin Wang Li-Huan Li Xin-Min Wu Guo-Jin Shan Yu Su Jun Li Qin-Jun Yu Chun-Xia Shi
Department of Anesthesiology, Peking University First Hospital, Beijing, China Department of Neurology, Peking University First Hospital, Beijing, China Department of Anesthesiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medica
国内会议
北京
英文
133-142
2011-08-18（万方平台首次上网日期，不代表论文的发表时间）