Neuroprotection of the brain during cardiopulmonary bypass - A randomized trial of remacemide during coronary artery bypass in 171 patients
Neuroprotection of the brain during cardiopulmonary bypass - A randomized trial of remacemide during coronary artery bypass in 171 patients
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DOI：
10.1161/01.str.29.11.2357
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发表时间：
1998-11-01
期刊：
影响因子：
8.3
通讯作者：
Pugsley, WB
中科院分区：
文献类型：
--
作者：
Arrowsmith, JE;Harrison, MJG;Pugsley, WB
背景和目的-冠状动脉搭桥手术后可能会因围手术期脑微栓塞而出现神经心理障碍。remacemide，NMDA受体拮抗剂，将提供保护，防止这种缺血性损伤的假设已被测试在一个随机trial. Methods一百七十一例接受冠状动脉搭桥手术的患者由一个单一的心胸外科手术组随机接受remacemide（高达150毫克，每6小时）或安慰剂从4天前至5天后，他们的旁路手术。围手术期监测包括通过经颅多普勒超声检查大脑中动脉检测到的微栓塞事件数量的估计。一组9神经心理学测试前和8周后surgery.Results-The患者的比例显示在2个或更多的测试1 SD或更多的性能下降减少治疗组（9%对12%），但这是没有统计学意义。另一方面，瑞马西胺组的总体术后变化（反映学习能力以及缺陷减少）更有利，其在总体z评分（P=0.028）和3项单独测试（P
Background and Purpose-Neuropsychological impairment may follow coronary artery bypass surgery as a result of peroperative cerebral microembolism. The hypothesis that remacemide, an NMDA receptor antagonist, would provide protection against such ischemic damage has been tested in a randomized trial.Methods-One hundred seventy-one patients undergoing coronary artery bypass surgery by a single cardiothoracic surgical team were randomized to receive remacemide (up to 150 mg every 6 hours) or placebo from 4 days before to 5 days after their bypass procedure. Peroperative monitoring included an estimate of the number of microembolic events detected by transcranial Doppler ultrasonography of the middle cerebral artery. A battery of 9 neuropsychological tests was administered before and 8 weeks after surgery.Results-The proportion of patients showing a decline in performance of 1 SD or more in 2 or more tests was reduced in the treated group (9% versus 12%), but this was not statistically significant. On the other hand, overall postoperative change (reflecting learning ability in addition to reduced deficits) was more favorable in the remacemide group, which demonstrated significantly greater improvement in a global z score (P=0.028) and changes in 3 individual tests (P