Association between early and three month cognitive outcome after off-pump and on-pump coronary bypass surgery
Association between early and three month cognitive outcome after off-pump and on-pump coronary bypass surgery
复制标题
非体外循环和体外循环冠状动脉搭桥手术后早期和三个月认知结果之间的关联
作者：
D. Dijk;D. Dijk;K. Moons;A. M. Keizer;E. Jansen;E. Jansen;R. Hijman;J. Diephuis;C. Borst;P. D. Jaegere;D. Grobbee;C. Kalkman
目的：描述非体外循环和体外循环冠状动脉搭桥手术后第一周的认知结果与术后3个月的认知结果之间的相关性，并直接比较非体外循环与体外循环手术后的早期认知结果。设计：随机试验，在两个随机组中进行额外的预测研究。背景：荷兰的三个心脏外科中心。患者：281例患者，平均年龄61岁。干预：参与者被随机分配到非体外循环或体外循环冠状动脉搭桥手术。主要结果指标：认知结果由心理学家评估，他们在手术前一天、手术后四天和三个月进行神经心理学测试。使用逻辑回归模型研究早期认知结果与8个临床变量以及3个月后的认知结果之间的预测关联。结果如下：对219名患者术后第一周的认知结果进行了测定，并将其作为三个月后认知能力下降的预测因素。这种关联在体外循环患者中（比值比（OR）5.24，p < 0.01）比非体外循环患者（OR 1.80，p = 0.23）更强。 54例患者（49%）在非体外循环手术后出现早期下降，61例患者（57%）在体外循环手术后出现早期下降（OR 0.73，p = 0.25）。 结论：在首次接受冠状动脉搭桥手术的患者中，早期认知功能下降可预测3个月后的认知结果。早期认知功能下降并不受心肺转流术的影响。
Objective: To describe the association between cognitive outcome in the first postoperative week and that at three months after both off-pump and on-pump coronary bypass surgery, and to make a direct comparison of early cognitive outcome after off-pump versus on-pump surgery. Design: Randomised trial with an additional prediction study within the two randomised groups. Setting: Three centres for heart surgery in the Netherlands. Patients: 281 patients, mean age 61 years. Interventions: Participants were randomly assigned to off-pump or on-pump coronary bypass surgery. Main outcome measures: Cognitive outcome, assessed by psychologists who administered neuropsychological tests one day before and four days and three months after surgery. A logistic regression model was used to study the predictive association between early cognitive outcome, together with eight clinical variables, and cognitive outcome after three months. Results: Cognitive outcome in the first week after surgery was determined for 219 patients and was a predictor of cognitive decline after three months. This association was stronger in on-pump patients (odds ratio (OR) 5.24, p < 0.01) than in off-pump patients (OR 1.80, p = 0.23). Early decline was present in 54 patients (49%) after off-pump surgery and 61 patients (57%) after on-pump surgery (OR 0.73, p = 0.25). Conclusions: In patients undergoing first time coronary bypass surgery, early cognitive decline predicts cognitive outcome after three months. Early cognitive decline is not significantly influenced by the use of cardiopulmonary bypass.
衰老对体外循环期间大脑自动调节的影响。
影响因子：
37.8
作者：
Newman,MF;Croughwell,ND;Blumenthal,JA;White,WD;Lewis,JB;Smith,LR;Frasco,P;Towner,EA;Schell,RM;Hurwitz,BJ
通讯作者：
Hurwitz,BJ
影响因子：
158.5
作者：
Newman, MF;Kirchner, JL;Blumenthal, JA
通讯作者：
Blumenthal, JA