Early benefit of preserved cognitive function is not sustained at one-year after cardiac surgery: a longitudinal follow-up of the randomized controlled trial
Early benefit of preserved cognitive function is not sustained at one-year after cardiac surgery: a longitudinal follow-up of the randomized controlled trial
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DOI：
10.1007/s12630-012-9675-y
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发表时间：
2012-05-01
影响因子：
4.2
通讯作者：
Karski, Jacek
中科院分区：
文献类型：
--
作者：
Djaiani, George;Katznelson, Rita;Karski, Jacek
最近，我们发现，在心肺转流术中使用连续流细胞回收器处理流出的血液，导致冠状动脉旁路移植术（CABG）术后6周后术后认知功能下降（POCD）的临床显著减少。目前的研究检查是否减少POCD的早期效益是持续在同一患者人群在一年follow.170例患者（细胞保存者组，n = 84;对照组，n = 86）进行了神经心理学测试在基线和术后一年。将每个测试的原始分数转换为Z分数，然后计算每个研究组的10个主要变量的组合Z分数。细胞回收组84名患者中有16名（19%）出现术后认知功能下降（95%置信区间[CI]，10.8 - 27.2）vs对照组86例患者中的15例（17.4%）（95% CI，9.6 - 25.2）（P = 0.786）。在对照组中，15名POCD患者中有6名在6周时出现了1年时的损伤，5名没有; 4名失访。6名POCD患者中有3名在6周时仍有损伤，2名没有，1名未进行测试。细胞回收器组和对照组分别有13例（15.4%）和9例（10.5%）患者出现新的POCD，在6周随访时，POCD并不明显。进展性脑血管疾病的存在可能是长期认知能力下降的原因。（ClinicalTrials.gov编号，NCT 00193999）。
Recently, we showed that processing of shed blood with a continuous-flow cell saver during cardiopulmonary bypass resulted in a clinically significant reduction in postoperative cognitive decline (POCD) six weeks after coronary artery bypass graft (CABG) surgery. The current study examined if the early benefit of reduced POCD was sustained in the same patient population at one-year follow-up.One hundred seventy patients (cell saver group, n = 84; controls, n = 86) underwent neuropsychological testing at baseline and one year after surgery. The raw scores for each test were converted to Z-scores, and a combined Z-score of ten main variables was then calculated for each study group.Postoperative cognitive decline was present in 16 of 84 (19%) patients in the cell saver group (95% confidence interval [CI], 10.8 to 27.2) vs 15 of 86 (17.4%) patients in the control group (95% CI, 9.6 to 25.2) (P = 0.786). Six of the 15 patients in the control group with POCD at six weeks had the impairment at one year and five did not; four were lost to follow-up. Three of the six cell saver patients with POCD at six weeks still had impairment at one year, two did not, and one was not tested. Thirteen (15.4%) and nine (10.5%) patients in the cell saver and control groups, respectively, developed new POCD which was not evident at the six-week follow-up.The short-term preservation of cognitive function in elderly patients using the cell saver management strategy did not translate into a long-term benefit one year after CABG surgery. The presence of progressing cerebrovascular disease may be responsible for the long-term cognitive decline. (ClinicalTrials.gov number, NCT00193999).