Cerebral ischemic lesions on diffusion-weighted imaging are associated with neurocognitive decline after cardiac surgery
Cerebral ischemic lesions on diffusion-weighted imaging are associated with neurocognitive decline after cardiac surgery
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DOI：
10.1161/strokeaha.107.502989
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发表时间：
2008-05-01
期刊：
影响因子：
8.3
通讯作者：
Milsom, Paget
中科院分区：
文献类型：
--
作者：
Barber, P. Alan;Hach, Sylvia;Milsom, Paget
背景和目的-心脏手术死亡率和发病率的改善使人们的兴趣集中在神经损伤上，如中风和认知能力下降，这可能伴随着其他成功的手术。我们的目的是研究(1)心脏瓣膜手术后卒中、新的MRI缺血性改变和认知功能障碍的发生率；(2)围手术期脑缺血与认知功能下降之间的有争议的关系。方法-40例心内手术患者(7例同时行冠状动脉搭桥术)，平均年龄62.1[13.7]岁。分别于手术前24小时、术后5天(MRI和神经病学)和6周(神经心理学和神经病学)进行神经学、神经心理学和MRI检查。结果：40名患者中有2名(5%)有围术期中风，35名患者中有22名(63%)至少有一项指标(范围为1至4)。37名接受术后影像检查的患者中，有16名(43%)出现了新的缺血性病变(范围为1-17个病变)，其表现与脑血栓栓塞术一致。术后有缺血性损害的患者和无缺血性损害的患者中，认知能力下降的比例分别为35%(P
Background and Purpose-Improvements in cardiac surgery mortality and morbidity have focused interest on the neurological injury such as stroke and cognitive decline that may accompany an otherwise successful operation. We aimed to investigate (1) the rate of stroke, new ischemic change on MRI, and cognitive impairment after cardiac valve surgery; and (2) the controversial relationship between perioperative cerebral ischemia and cognitive decline.Methods-Forty patients (26 men; mean [SD] age 62.1 [13.7] years) undergoing intracardiac surgery (7 also with coronary artery bypass grafting) were studied. Neurological, neuropsychological, and MRI examinations were performed 24 hours before surgery and 5 days (MRI and neurology) and 6 weeks (neuropsychology and neurology) after surgery. Cognitive decline from baseline was determined using the Reliable Change Index.Results-Two of 40 (5%) patients had perioperative strokes and 22 of 35 (63%) tested had cognitive decline in at least one measure (range, 1 to 4). Sixteen of 37 participants (43%) with postoperative imaging had new ischemic lesions (range, 1 to 17 lesions) with appearances consistent with cerebral embolization. Cognitive decline was seen in all patients with, and 35% of those without, postoperative ischemic lesions (P