Brain damage during cardiopulmonary bypass.
Brain damage during cardiopulmonary bypass.
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DOI：
10.1016/s0003-4975(98)00072-1
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发表时间：
1998-04
期刊：
影响因子：
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通讯作者：
K. M. Taylor
中科院分区：
文献类型：
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作者：
K. M. Taylor
心肺转流系统的开发促进了我们专业的发展。近年来，与心脏手术相关的死亡率持续下降，增强了我们对灌注设备可靠性和安全性的信心。心脏外科医生意识到，大多数心脏外科手术的死亡率已显着下降，总体发病率也已显着降低。然而，很明显体外循环技术并不完美。事实上，可以公平地说，搭桥期间仍然是大多数患者显着发病的原因之一。特别是，本次审查的重点脑损伤对于患者及其护理人员以及医疗保健系统的资金来说是一个重大问题。中风的发病率约为 2% 至 3%，老年患者和其他高危人群的风险增加。这种被普遍认为是严重并发症的相对较低的发生率可能与神经心理学测试评估的认知缺陷的较高发生率形成鲜明对比。术后 8 天认知缺陷的发生率高达 60%，而在 8 周和 12 个月时认知缺陷的发生率降至 25% 至 30%。在体外循环手术中，大脑可能会以多种方式（至少是潜在的）受到损伤，包括脑血流量减少、微栓塞和大栓塞以及全身炎症反应。这些机制相互关联，并对手术期间和手术后的大脑功能产生协同、累积效应。减少这种大脑功能改变的发生率和影响将依赖于预防和治疗策略。反过来，这些必须基于对脑损伤这些机制的病理生理学的理解，并针对优化脑灌注、尽量减少栓塞性血管闭塞以及开发改变全身炎症反应的药理学方法的方法。
The development of systems that allow cardiopulmonary bypass have been responsible for the growth of our specialty. In recent years continuing reduction in the mortality associated with cardiac operations has reinforced our confidence in the reliability and safety of perfusion equipment. Cardiac surgeons are aware that the mortality for most cardiac surgical procedures has decreased dramatically and overall morbidity has been reduced significantly. However, it is still clear that cardiopulmonary bypass techniques are not perfect. Indeed, it is fair to say that the period of bypass still contributes to significant morbidity in most patients. In particular, cerebral injury, the focus of this review, is a significant problem for patients and their caregivers and for funding of health-care systems. Incidence rates for stroke are around 2% to 3%, with increased risk in elderly patients and other high-risk groups. This relatively low incidence of what is universally recognized as a serious complication may be contrasted with the much higher reported incidence of cognitive defects assessed by neuropsychologic testing. The incidence of cognitive defects is as high as 60% at 8 days postoperative with reduction to 25% to 30% incidence at 8 weeks and 12 months. There are a variety of ways, at least potentially, in which the brain may be injured during an operation with cardiopulmonary bypass, including reduced cerebral blood flow, microembolism and macroembolism, and a systemic inflammatory response. These mechanisms interrelate and produce synergistic, cumulative effects on brain function during and after the operation. Reducing the incidence and effects of this altered brain function will rely on both preventive and therapeutic strategies. These, in turn, must be based on an understanding of the pathophysiology of these mechanisms of cerebral injury and directed toward ways to optimize cerebral perfusion, minimize embolic vascular occlusion, and develop pharmacologic approaches to modify the systemic inflammatory response.