Neurologic complications of cardiac surgery: current concepts and recent advances.
Neurologic complications of cardiac surgery: current concepts and recent advances.
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DOI：
10.1007/s11886-006-0004-3
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发表时间：
2006-02-01
影响因子：
3.7
通讯作者：
Bronster, David J
中科院分区：
文献类型：
--
作者：
Bronster, David J
心脏手术后的神经系统并发症导致发病率和死亡率增加。中风的发生率为2%至4%，但在有中风病史的患者中明显更高。非体外循环技术在改变这种风险方面的成功是有争议的。颈动脉内膜剥脱术联合冠状动脉搭桥术的有效性和安全性仍有争议。机械取栓器可能为治疗术后大脑中动脉大卒中提供新的机会。认知缺陷的风险是有争议的，但可能是由于使用旁路以外的因素，可能与非心脏手术后的类似缺陷没有区别。短期认知缺陷通常会在1至3个月内解决。长期风险尚未明确确定。新的方法可能会降低神经认知功能障碍的发生率。术后癫痫发作可能是由于灌注不足、颗粒或空气栓塞或代谢原因引起的全脑或局灶性脑缺血所致。较新的抗惊厥药物可能提供额外的管理机会。
Neurologic complications following cardiac surgery result in increased morbidity and mortality. The incidence of stroke is 2% to 4%, but is substantially higher in patients with a prior history of stroke. The success of off-pump techniques in altering this risk is controversial. The efficacy and safety of simultaneous carotid endarterectomy and coronary artery bypass surgery are still debated. Mechanical clot retrievers may offer new opportunity to treat postoperative large, middle cerebral artery strokes. The risk of cognitive deficits is debatable but may be due to factors other than the use of bypass and may not differ from similar deficits after noncardiac surgery. Short-term cognitive deficits usually resolve by 1 to 3 months. Long-term risks are not clearly established. Novel approaches may decrease the incidence of neurocognitive dysfunction. Postoperative seizures may result from global or focal cerebral ischemia due to hypoperfusion, particulate or air emboli, or metabolic causes. Newer anticonvulsant drugs may offer additional management opportunities.