Predictors of neurocognitive decline after carotid endarterectomy
Predictors of neurocognitive decline after carotid endarterectomy
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DOI：
10.1227/01.neu.0000209638.62401.7e
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发表时间：
2006-05-01
期刊：
影响因子：
4.8
通讯作者：
Heyer, EJ
中科院分区：
文献类型：
--
作者：
Mocco, J;Wilson, DA;Heyer, EJ
目的：虽然颈动脉内膜切除术（CEA）后卒中的发生率较低（1 - 3%），但约25%的患者术后神经心理功能轻微下降。没有研究调查这种神经认知变化的风险因素。我们试图确定术后神经认知功能障碍的预测因素。方法：我们招募了186例CEA患者，有症状和无症状的狭窄，进行一系列的神经心理测试术前和术后第1天和第30天。神经认知功能障碍被定义为与年龄相似的腰椎椎板切除术患者对照组相比，两个标准差的性能下降。对年龄、性别、肥胖、吸烟、糖尿病、糖尿病、高血压、高胆固醇血症、他汀类药物的使用、既往心肌梗死、既往CEA、手术侧、手术持续时间、颈动脉阻断持续时间以及体重调整的咪达唑仑和芬太尼剂量进行单变量logistic回归分析。达到单变量P <0.10的变量包括在多变量分析中。数据表示为（比值比，95%置信区间，P值）。结果：18例和9%的CEA患者分别在术后第1天和第30天受伤。高龄预测第1天和第30天的神经认知功能障碍（分别为1.93/10，1.15 - 3.25，0.01;和2.57/10，1.01 - 6.51，0.049）。此外，糖尿病独立预测第30天损伤（4.26，1.15 - 15.79，0.03）。结论：高龄和糖尿病易患CEA后神经认知功能障碍。这些结果与冠状动脉搭桥术后神经认知功能障碍和CEA后严重卒中的风险因素一致，支持潜在的缺血性病理生理学。进一步的工作是必要的，以确定这些神经认知缺陷可能发挥的作用，在适当选择患者的CEA。
OBJECTIVE: Although the incidence of stroke after carotid endarterectomy (CEA) is low (1-3%), approximately 25% of patients experience subtle declines in postoperative neuropsychometric function. No studies have investigated the risk factors for this neurocognitive change. We sought to identify predictors of postoperative neurocognitive dysfunction.METHODS: We enrolled 186 CEA patients, with both symptomatic and asymptomatic stenosis, to undergo a battery of neuropsychometric tests preoperatively and on postoperative Days 1 and 30. Neurocognitive dysfunction was defined as a two standard deviation decline in performance compared with a similarly aged control group of lumbar laminectomy patients. Univariate logistic regression was performed for age, sex, obesity, smoking, symptomatology, diabetes mellitus, hypertension, hypercholesterolemia, use of statin medication, previous myocardial infarction, previous CEA, operative side, duration of surgery, duration of carotid cross-clamp, and weight-adjusted doses of midazolam and fentanyl. Variables achieving univariate P < 0.10 were included in a multivariate analysis. Data is presented as (odds ratio, 95% confidence interval, P-value).RESULTS: Eighteen and 9% of CEA patients were injured on postoperative Days 1 and 30, respectively. Advanced age predicted neurocognitive dysfunction on Days 1 and 30 (1.93 per decade, 1.15-3.25, 0.01; and 2.57 per decade, 1.01-6.51, 0.049, respectively). Additionally, diabetes independently predicted injury on Day 30 (4.26, 1.15-15.79, 0.03).CONCLUSIONS: Advanced age and diabetes predispose to neurocognitive dysfunction after CEA. These results are consistent with risk factors for neurocognitive dysfunction after coronary bypass and major stroke after CEA, supporting an underlying ischemic pathophysiology. Further work is necessary to determine the role these neurocognitive deficits may play in appropriately selecting patients for CEA.