Impaired cognition preceding cardiac surgery is related to cerebral ischemic lesions
Impaired cognition preceding cardiac surgery is related to cerebral ischemic lesions
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心脏手术前的认知受损与脑缺血性病变有关
DOI：
--
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发表时间：
2011
影响因子：
2.8
通讯作者：
Tatsuo Yamamoto
中科院分区：
文献类型：
--
作者：
K. Maekawa;T. Gotō;T. Baba;A. Yoshitake;K. Katahira;Tatsuo Yamamoto
目的心脏手术后认知功能障碍更为常见。然而，术前的认知状态很少被评估时，心脏手术对认知的影响进行了调查。术后认知功能障碍可能与术前的认知状态和脑缺血性病变的患者接受心脏surgery.MethodsData的存在，前瞻性地收集了362例连续患者进行择期心脏手术。所有患者的脑部均通过磁共振成像（MRI）进行成像，以评估既往脑梗死、颈动脉狭窄和颅内动脉狭窄，并使用弥散加权成像（DWI）评估急性脑缺血。如果患者在长谷川痴呆评定量表上的得分<24，则在手术前将其归类为认知功能受损。术后认知功能障碍从基线确定使用四个神经心理学tests. ResultsBefore手术40例（11%）进行了评估与认知受损。与其他患者相比，这些患者年龄较大，受教育程度较低，外周血管疾病、白色病变、MRI显示的脑梗死、颈动脉狭窄和术后认知功能障碍的发生率显著较高。在这40例认知功能受损的患者中，根据术前DWI图像，7例（18%）有脑缺血;相比之下，322例术前无认知功能受损的患者中有9例（3%）在DWI图像上发现异常（P < 0.001）。逐步Logistic回归分析显示，高龄、文化程度低、外周动脉疾病、既往脑梗死、结论这些结果表明，术前认知功能障碍与脑缺血性病变和术后认知功能障碍的风险增加，存在于我们的患者队列接受心脏手术
PurposeCognitive dysfunction is more frequent after cardiac surgery. However, the preoperative cognitive state is seldom assessed when the effects of cardiac surgery on cognition are investigated. Postoperative cognitive dysfunction may be associated with the preoperative cognitive state and the existence of cerebral ischemic lesions in patients who undergo cardiac surgery.MethodsData were collected prospectively on 362 consecutive patients scheduled to undergo elective cardiac surgery. The brains of all patients were imaged by magnetic resonance imaging (MRI) to assess prior cerebral infarctions, carotid artery stenosis and intracranial arterial stenosis, and diffusion-weighted imaging (DWI) was used to assess acute cerebral ischemia. Patients were classified with impaired cognitive function prior to surgery if their score on the Hasegawa dementia rating scale was <24. Postoperative cognitive dysfunction from baseline was determined using four neuropsychological tests.ResultsPrior to surgery 40 patients (11%) were assessed with impaired cognition. Relative to the other patients, these patients were older and less well educated, and they had significantly higher rates of peripheral vascular disease, white matter lesions, cerebral infarction on MRI, carotid artery stenosis and postoperative cognitive dysfunction. Of these 40 cognitively impaired patients, seven (18%) had cerebral ischemia, based on DWI images before surgery; in comparison, nine of the 322 patients (3%) without preoperative cognitive impairment were found to have abnormalities on the DWI images (P < 0.001). An analysis by stepwise logistic regression demonstrated that the significant risks for preoperative cognitive impairment were advanced age, lower attained level of education, peripheral artery disease, prior cerebral infarctions, and abnormalities on DWI images.ConclusionsThese findings suggest that preoperative cognitive impairment associated with cerebral ischemic lesions and an increased risk of postoperative cognitive dysfunction existed in our patient cohort undergoing cardiac surgery.
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DOI：
10.1001/jama.1994.03510370056032
发表时间：
1994-04
期刊：
JAMA
影响因子：
--
作者：
Y. Stern;B. Gurland;T. Tatemichi;M. Tang;D. Wilder;R. Mayeux
通讯作者：
Y. Stern;B. Gurland;T. Tatemichi;M. Tang;D. Wilder;R. Mayeux
影响因子：
8.3
作者：
Swan, GE;Carmelli, D;Larue, A
通讯作者：
Larue, A
影响因子：
5
作者：
FAZEKAS, F;CHAWLUK, JB;ZIMMERMAN, RA
通讯作者：
ZIMMERMAN, RA
影响因子：
158.5
作者：
Newman, MF;Kirchner, JL;Blumenthal, JA
通讯作者：
Blumenthal, JA