Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators.
Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators.
复制标题
冠状动脉搭桥手术后的不良脑结果。
DOI：
--
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发表时间：
1996
影响因子：
158.5
通讯作者：
C. Ley
中科院分区：
文献类型：
--
作者：
G. Roach;M. Kanchuger;C. Mangano;M. Newman;N. Nussmeier;R. Wolman;A. Aggarwal;K. Marschall;S. Graham;C. Ley
背景
择期冠状动脉搭桥手术后脑功能的急性变化是一个棘手的临床问题。我们进行了一项多中心研究，以确定围手术期不良神经系统事件（包括脑损伤）的发生率和预测因素以及与之相关的资源的使用。
方法
在一项前瞻性研究中，我们评估了来自 24 个美国机构的 2108 名患者的两大类神经系统结果：I 型（局灶性损伤、出院时木僵或昏迷）和 II 型（智力功能恶化、记忆缺陷或癫痫发作）。
结果
129 名患者（6.1%）出现不良脑部结局。共有 3.1% 的人出现 I 型神经系统结局（8 人死于脑损伤，55 人患有非致命性中风，2 人患有短暂性脑缺血发作，1 人昏迷），3.0% 的人患有 II 型结局（55 人智力功能恶化，8 人癫痫发作）。脑部不良结局患者的院内死亡率较高（I 型结局患者死亡率为 21%，II 型结局患者死亡率为 10%，无不良脑结局患者为 2%；所有比较 P<0.001）、住院时间较长（I 型结局为 25 天，II 型结局为 21 天，无不良结局为 10 天；P<0.001），出院至中长期护理机构的比率较高（69%、39% 和 10%；P<0.001）。 I 型结果的预测因素是近端主动脉粥样硬化、神经系统疾病史和年龄较大； II 型结局的预测因素包括年龄较大、入院时出现收缩性高血压、肺部疾病和过量饮酒。
结论
冠状动脉搭桥手术后的脑部不良后果相对常见且严重；它们与死亡率、住院时间和使用中长期护理设施的大幅增加有关。必须开发新的诊断和治疗策略来减轻这种损伤。
BACKGROUND
Acute changes in cerebral function after elective coronary bypass surgery is a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of -- and the use of resources associated with -- perioperative adverse neurologic events, including cerebral injury.
METHODS
In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures).
RESULTS
Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients with type I outcomes died, vs. 10 percent of those with type II and 2 percent of those with no adverse cerebral outcome; P<0.001 for all comparisons), longer hospitalization (25 days with type I outcomes, 21 days with type II, and 10 days with no adverse outcome; P<0.001), and a higher rate of discharge to facilities for intermediate- or long-term care (69 percent, 39 percent, and 10 percent ; P<0.001). Predictors of type I outcomes were proximal aortic atherosclerosis, a history of neurologic disease, and older age; predictors of type II outcomes were older age, systolic hypertension on admission, pulmonary disease, and excessive consumption of alcohol.
CONCLUSIONS
Adverse cerebral outcomes after coronary bypass surgery are relatively common and serious; they are associated with substantial increases in mortality, length of hospitalization, and use of intermediate- or long-term care facilities. New diagnostic and therapeutic strategies must be developed to lessen such injury.