The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery
The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery
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DOI：
10.1097/00000539-200201000-00002
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发表时间：
2002-01-01
影响因子：
5.7
通讯作者：
Newman, MF
中科院分区：
文献类型：
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作者：
Grigore, AM;Grocott, HP;Newman, MF
神经认知功能障碍是心脏手术后常见的并发症。在这项前瞻性研究中，我们评估了复温速度对低温体外循环(CPB)后神经认知结果的影响。在IRB批准和知情同意后，对165名冠状动脉搭桥术患者进行了研究。患者接受类似的手术和麻醉处理，直到低温(28摄氏度-32摄氏度)CIPB复温。第1组(对照组，n=100)按常规方式加温(鼻咽与CPB灌流温差4℃~6℃)，第2组(慢速复温，n=65)，加温速率较慢，鼻咽与CPB灌流温差不超过2℃。分别于术前和术后6wk评定神经认知功能。单变量分析显示，控制组和缓慢复温组之间的卒中发生率没有显著差异。多元线性回归分析显示，治疗组、糖尿病、基础认知功能、阻断时间与认知功能改变有显著相关性(P=0.05)。
Neurocognitive dysfunction is a common complication after cardiac surgery. We evaluated in this prospective study the effect of rewarming rate on neurocognitive outcome after hypothermic cardiopulmonary bypass (CPB). After IRB approval and informed consent, 165 coronary artery bypass graft surgery patients were studied. Patients received similar surgical and anesthetic management until rewarming from hypothermic (28degrees-32degreesC) CIPB. Group 1 (control; n=100) was warmed in a conventional manner (4degrees-6degreesC gradient between nasopharyngeal and CPB perfusate temperature) whereas Group 2 (slow rewarm; n=65) was warmed at a slower rate, maintaining no more than 2degreesC difference between nasopharyngeal and CPB perfusate temperature. Neurocognitive function was assessed at baseline and 6 wk after coronary artery bypass graft surgery. Univariable analysis revealed no significant differences between the Control and Slow Rewarming groups in the stroke rate. Muitivariable linear regression analysis, examining treatment group, diabetes, baseline cognitive function, and cross-clamp time revealed a significant association between change in cognitive function and rate of rewarming (P=0.05).