RESIDUAL COGNITIVE DYSFUNCTIONING AT 6 MONTHS FOLLOWING CORONARY-ARTERY BYPASS GRAFT-SURGERY
RESIDUAL COGNITIVE DYSFUNCTIONING AT 6 MONTHS FOLLOWING CORONARY-ARTERY BYPASS GRAFT-SURGERY
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DOI：
10.1016/s1010-7940(05)80110-1
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发表时间：
1995-11-01
影响因子：
3.4
通讯作者：
HUYSMANS, HA
中科院分区：
文献类型：
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作者：
BRUGGEMANS, EF;VANDIJK, JG;HUYSMANS, HA
神经心理测试是定量评估体外循环(CPB)术后认知功能障碍的一种敏感方法。然而，与该方法相关的方法学问题，如重复测试引起的学习效应和痛苦对测试成绩的影响，往往被低估。在本研究中，通过将患者的配偶暴露于与手术相同的潜在应激效应来控制这些混杂影响。作为非手术对照组，包括63例(40~75岁)择期冠状动脉旁路手术(CABG)患者，两组均在术前2周、1周、1个月、1周、1个月进行一系列标准化神经心理测试。术后6个月。统计学检验结果显示：(1)在即刻记忆和学习方面，两组患者的即刻记忆和学习成绩总体上表现为相同的时间进程；(2)在近期记忆方面，患者在CABG术后1个月时与配偶的得分相比有明显的恶化，这种影响在术后6个月仍未完全消失。(3)患者的注意力、精神运动速度和语言流利性在术后1周已显著下降，6个月后完全恢复，这些负性认知效应与患者的年龄或CPB参数(CPB时间、主动脉阻断时间、CPB和主动脉阻断时的平均流量和动脉压、最低鼻咽温度)无关，患者与配偶在随时间推移的情绪自评量表上没有差异，结果表明，在充分控制学习和痛苦的影响后，CABG术后6个月仍有部分认知功能受损。
Neuropsychological testing is a sensitive method for quantitative assessment of cognitive dysfunctioning following cardiopulmonary bypass (CPB), However, the methodological problems associated with this method, such as learning effects due to repeated testing and the effects of distress on test performance, have often been underestimated, In this study, these confounding effects were controlled for by including the spouses of patients, exposed to the same potential stress effects associated with the operation, as a nonsurgical control group, The experimental group consisted of 63 patients (40-75 years) undergoing elective coronary artery bypass graft (CABG) surgery, A battery of standardized neuropsychological tests was administered to both groups 2 weeks preoperatively and 1 week, 1 month, and 6 months postoperatively. Statistical testing of inter-group differences in preoperative to postoperative changes in test performance revealed the following results: (1) For immediate memory and learning, in general test scores showed the same time course for both groups, (2) For recent memory, patients' scores showed a significant deterioration at 1 month after CABG surgery compared with the scores of spouses, This effect had not completely disappeared at 6 months postoperatively. (3) For attention and psychomotor speed as well as verbal fluency, patients' scores had deteriorated significantly at 1 week after surgery, with incomplete recovery at 6 months, These negative cognitive effects were not related to the patients' ages or CPB parameters (duration of CPB, aortic cross-clamp time, mean flow and arterial pressure during CPB and aortic cross-clamping, and minimum nasopharyngeal temperature), No differences in self-ratings of mood over time were found between the patients and spouses, The results indicate that, when adequately controlling for the effects of learning and distress, some cognitive functions are still impaired at 6 months after CABG surgery.