Association between cerebrovascular carbon dioxide reactivity and postoperative short-term and long-term cognitive dysfunction in patients with diabetes mellitus.
Association between cerebrovascular carbon dioxide reactivity and postoperative short-term and long-term cognitive dysfunction in patients with diabetes mellitus.
复制标题
糖尿病患者脑血管二氧化碳反应性与术后短期和长期认知功能障碍的关系。
DOI：
10.1007/s00540-011-1182-8
复制
发表时间：
2011
期刊：
影响因子：
2.8
通讯作者：
Mizutani A.
中科院分区：
文献类型：
--
作者：
Kadoi Y;Kawauchi C;Kuroda M;Takahashi K;Saito S;Fujita N;Mizutani A.
PurposeOur intention is to identify whether cerebrovascular CO2 reactivity in diabetic patients are a risk factor for postoperative cognitive dysfunction after coronary artery bypass graft（CABG）surgery.MethodsOne 24 diabetes patients undergoing elective CABG were studied and analyzed.将糖尿病患者分为3组：正常CO2反应性组（> 5%/mmHg）、中等CO2反应性组（5 ~ 3%/mmHg）和受损CO2反应性组（<3%/mmHg）。在麻醉诱导后和手术开始前，测量所有患者的脑血管CO2反应性。在体外循环过程中测量血流动力学参数（动脉和颈静脉血气值）。所有患者在术前一天、术后7天、术后6个月进行了一系列神经和神经心理学测试。结果术后7天，CO2受损组的认知功能障碍率高于其他三组（正常组30%，中等组25%，受损组57%，与其他组相比，P< 0.01）。相比之下，术后6个月，三组之间的认知功能障碍发生率无显著差异。年龄、高血压、CO2反应性、颈静脉血氧饱和度（SjvO 2）低于50%的持续时间、升主动脉粥样硬化、糖尿病视网膜病变和胰岛素治疗是糖尿病患者短期认知功能障碍的独立预测因素，HbA 1c、糖尿病视网膜病变、和胰岛素治疗是长期-结论我们发现脑血管CO2反应性受损与糖尿病患者术后短期认知功能障碍有关。
PurposeOur intent was to identify whether cerebrovascular CO2reactivity in diabetic patients is a risk factor for postoperative cognitive dysfunction after coronary artery bypass graft (CABG) surgery.MethodsOne hundred twenty-four diabetic patients undergoing elective CABG were studied and analyzed. Diabetic patients were divided into three groups: normal CO2reactivity group (above 5%/mmHg), medium CO2reactivity group (between 5 and 3%/mmHg), or impaired CO2reactivity group (below 3%/mmHg). After the induction of anesthesia and before the start of surgery, cerebrovascular CO2reactivity was measured for all patients. Hemodynamic parameters (arterial and jugular venous blood gas values) were measured during cardiopulmonary bypass. All patients underwent a battery of neurological and neuropsychological tests the day before surgery, 7 days after surgery, and 6 months after surgery.ResultsAt 7 days, the rate of cognitive dysfunction in the impaired CO2group was higher than in the other three groups (normal, 30%; medium, 25%; impaired, 57%; *P< 0.01 compared with the other groups). In contrast, at 6 months postoperatively, no significant difference in the rate of cognitive dysfunction was found among the three groups. Age, hypertension, CO2reactivity, the duration for which jugular venous oxygen saturation (SjvO2) was less than 50%, ascending aorta atherosclerosis, diabetic retinopathy, and insulin therapy were independent predictors of short-term cognitive dysfunction in diabetic patients, and HbA1c, diabetic retinopathy, and insulin therapy were independent predictors of long-term cognitive dysfunction in diabetic patients.ConclusionsWe found that impaired cerebrovascular CO2reactivity was associated with postoperative short-term cognitive dysfunction in diabetic patients.