The role of postoperative neurocognitive dysfunction on quality of life for postmenopausal women 6 months after cardiac surgery.
The role of postoperative neurocognitive dysfunction on quality of life for postmenopausal women 6 months after cardiac surgery.
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DOI：
10.1213/ane.0b013e3181606a65
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发表时间：
2008-07
影响因子：
5.7
通讯作者：
Freedland K
中科院分区：
文献类型：
--
作者：
Hogue CW Jr;Fucetola R;Hershey T;Nassief A;Birge S;Dávila-Román VG;Barzilai B;Thomas B;Schechtman KB;Freedland K
女性心脏手术后容易出现神经系统并发症。我们以前曾报道过，老年妇女手术后4到6周，围手术期使用神经保护剂17β-雌二醇治疗并没有改善神经认知终点。在这项研究中，我们评估了术后早期神经认知功能障碍对接受心脏手术的绝经后妇女生活质量的影响，以及围术期17β-雌二醇治疗是否会对其产生影响。174名绝经后妇女从手术前一天开始以双盲方式随机接受17β-雌二醇或安慰剂，一直持续到手术后第五天。患者在手术前、术后4~6wk和6mo分别用标准电池组进行心理测试。分别于术前和术后6个月采用SF-36问卷和Lawton日常生活活动量表评定患者的生活质量。108名女性获得了完整的数据，其中13%的患者术后出现神经认知功能障碍。多因素Logistic回归分析显示，术后4~6wk神经认知功能障碍是术后6个月SF-36身体成分评分降低(P=0.004)和Lawton日常生活能力量表评分降低(P=0.026)的独立预测因素。17β-雌二醇治疗(P=0.003)和吸烟状况(P=0.015)是SF-36心理健康部分评分较差的预测因素。在所有测量中，术前低分值与术后低生活质量独立相关。术后神经认知功能障碍与女性心脏手术后生活质量受损有关。围手术期应用17β-雌二醇对术后生活质量无明显改善作用。较低的术前和术后自评健康状况之间的关系表明，绝经后妇女的生活质量的某些方面不能通过心脏手术来改善。
Women are prone to neurological complications after cardiac surgery. We have previously reported that treatment perioperatively with the neuroprotectant steroid 17β-estradiol did not improve neurocognitive end-points 4 to 6 wk after surgery for elderly women. In this study, we evaluated the influence of early postoperative neurocognitive dysfunction on quality of life in postmenopausal women undergoing cardiac surgery and whether it is impacted by perioperative 17β-estradiol treatment. One hundred seventy-four postmenopausal women randomly received 17β-estradiol or placebo in a double-blind manner beginning the day before surgery and continued until the fifth postoperative day. The patients underwent psychometric testing using a standard battery before surgery and again 4 to 6 wk and 6 mo postoperatively. Quality of life was assessed at baseline and 6 mo after surgery with the SF-36 questionnaire and the Lawton instrumental activities of daily living scale. Complete data were available from 108 women of whom 13% demonstrated postoperative neurocognitive dysfunction. Based on multiple logistic regression analysis, a neurocognitive deficit 4 to 6 wk after surgery was an independent predictor of a lower SF-36 physical component score (P = 0.004) and lower Lawton instrumental activities of daily living scale 6 mo postoperatively (P = 0.026). Treatment with 17β-estradiol (P = 0.003) and smoking status (P = 0.015) were predictors of worse SF-36 mental health component rating. Preoperative lower scores were independently associated with low quality of life postoperatively for all measurements. Postoperative neurocognitive dysfunction is associated with impaired quality of life in women after cardiac surgery. Perioperative treatment with 17β-estradiol provides no benefits to postoperative quality of life. The relationship between low preoperative and postoperative self-rated health status suggests that some aspects of quality of life in postmenopausal women are not amenable to improvements with cardiac surgery.
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影响因子：
8.8
作者：
Hogue, CW;Sundt, T;Dávila-Román, VG
通讯作者：
Dávila-Román, VG
影响因子：
3.3
作者：
Bute, BP;Mathew, J;Newman, MF
通讯作者：
Newman, MF
影响因子：
--
作者：
GOLDSTEIN, LB;BERTELS, C;DAVIS, JN
通讯作者：
DAVIS, JN
影响因子：
--
作者：
Ho, PM;Masoudi, FA;Rumsfeld, JS
通讯作者：
Rumsfeld, JS
影响因子：
2.5
作者：
King, K M
通讯作者：
King, K M