Similar neurobehavioral outcome after valve or coronary artery operations despite differing carotid embolic counts.
Similar neurobehavioral outcome after valve or coronary artery operations despite differing carotid embolic counts.
复制标题
尽管颈动脉栓塞数量不同，但瓣膜或冠状动脉手术后的神经行为结果相似。
DOI：
10.1067/mtc.2001.111378
复制
发表时间：
2001
期刊：
影响因子：
--
通讯作者：
Stump,DA
中科院分区：
文献类型：
--
作者：
Neville,MJ;Butterworth,J;James,RL;Hammon,JW;Stump,DA
目的冠状动脉和瓣膜手术、微栓子和神经行为结果之间的相互关系尚不清楚。我们假设，接受心脏瓣膜手术的成年患者将有更多的总栓塞比接受冠状动脉旁路移植术的患者，这将与更糟糕的神经行为outcome.MethodsOne九十三例接受冠状动脉旁路移植术和73例接受心脏瓣膜手术的患者进行了比较。患者在术前和术后5 - 7天、1个月和6个月接受神经学、神经眼科和11项标准化神经行为测试。术中进行左颈总动脉多普勒超声栓子检测。重复测量和Logistic回归分析的结果performed.ResultsPatients接受冠状动脉或瓣膜手术是匹配的年龄（61 ± 10和59 ± 12岁，分别），但一个显着更大的比例进行瓣膜手术的患者是女性，糖尿病，或经历了以前的心脏手术。接受冠状动脉旁路移植术或心脏瓣膜手术的患者的神经行为评分在任何时候都没有显著差异。总栓子计数差异显著：冠状动脉旁路移植术期间的中位数为105，心脏瓣膜手术期间为479（几何平均值分别为104和412; P = 0.0001）。在移除左心室排气口后和与体外循环分离后接受心脏瓣膜手术的患者中检测到明显更多的栓塞，但在体外循环前，两组中观察到的栓塞数量相当。在两组中，神经行为表现在5至7天明显下降，在1个月和6个月时有所改善。颈动脉栓塞数量的增加与字母取消测试的表现较差显著相关。接受瓣膜和冠状动脉手术的患者在神经行为结局、中风、短暂性脑缺血发作或死亡率方面无显著差异。ConclusionsThe显着更大数量的栓塞在接受心脏瓣膜手术的患者组中可能是心内空气夹带的结果。心脏瓣膜手术中更多的栓塞似乎与神经系统或神经行为不良结局的风险显著增加无关。（《胸血管外科杂志》2001;121：125-36）
ObjectivesThe interrelationships among coronary and valvular operations, microemboli, and neurobehavioral outcome are unclear. We hypothesized that adult patients undergoing cardiac valve operations would have more total emboli delivered to the brain than patients undergoing coronary artery bypass grafting and that this would associate with worse neurobehavioral outcomes.MethodsOne hundred ninety-three patients undergoing coronary artery bypass grafting and 73 patients undergoing cardiac valve operations were compared. Patients received neurologic, neuro-ophthalmologic, and 11 standardized neurobehavioral tests preoperatively and 5 to 7 days, 1 month, and 6 months postoperatively. Left common carotid Doppler ultrasonographic embolus detection was performed intraoperatively. Repeated measures and logistic regression analyses of outcome were performed.ResultsPatients undergoing either coronary or valve operations were well matched by age (61 ± 10 and 59 ± 12 years, respectively), but a significantly greater fraction of patients undergoing valve operations were female, diabetic, or had undergone previous cardiac operations. Neurobehavioral scores of patients undergoing either coronary artery bypass grafting or cardiac valve operations did not differ significantly at any time. Total embolus counts differed significantly: the median was 105 during coronary artery bypass grafting and 479 during cardiac valve operations (geometric means of 104 and 412, respectively; P = .0001). Significantly more emboli were detected in the patients undergoing cardiac valve operations after removal of the left ventricular vent and after separation from cardiopulmonary bypass, but comparable numbers of emboli were seen in the 2 groups before cardiopulmonary bypass. In both groups decreased neurobehavioral performance was apparent at 5 to 7 days, with improvement at 1 and 6 months. Increasing numbers of carotid emboli significantly associated with worse performance on the letter cancellation test. There were no significant differences between patients undergoing valve and coronary operations in neurobehavioral outcomes, strokes, transient ischemic attacks, or deaths.ConclusionsThe significantly greater number of emboli in the group of patients undergoing cardiac valve operations is likely the result of the entrainment of intracardiac air. The greater numbers of emboli during cardiac valve operations do not appear associated with a commensurately greater risk of adverse neurologic or neurobehavioral outcome. (J Thorac Cardiovasc Surg 2001;121:125-36)