AGING AND COGNITION AFTER CARDIAC SURGERY

心脏手术后的衰老和认知

• 批准号: 2766666
• 负责人: JOSEPH G REVES
• 金额: $ 33.29万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1991
• 资助国家: 美国
• 起止时间: 1991-02-15 至 2004-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2766666
• 关键词: aging; biomarker; blood cell count; blood viscosity; brain injury; cerebral ischemia /hypoxia; clinical research; clinical trials; cognition disorders; coronary bypass; disease /disorder proneness /risk; functional ability; human old age (65+); human subject; injury prevention; longitudinal human study; neuropsychological tests; oxygen consumption; oxygen transport; postoperative complications; quality of life; thromboembolism

Elderly patients are increasingly undergoing cardiac surgery and this trend is forecasted to continue. A very common and disturbing consequence of this surgery is deterioration in cognitive function. This impairment can be as high as 83% in the hospital and continue in up to 30% or more of patients for over a year. Elderly patients are particularly susceptible to this neurocognitive consequence of life- preserving surgery. This cause of cognitive dysfunction is postulate to be a result of cerebral emboli that occur during cardiac surgery. The cause of cognitive dysfunction is postulated to be a result of cerebral emboli that occur during cardiac surgery, which are impossible to prevent, and therefore strategies to protect the brain must be developed. It has become standard practice in cardiac surgery to allow the hematocrit advantages to blood flow during hypothermic cardiopulmonary bypass and fear of adverse consequences of transfusion. It is not known whether this hemodilution (50% reduction in oxygen carrying capacity of the blood) contributes to brain injury and cognitive impairment. We will test the hypothesis that preserving oxygen carrying capacity of the blood by limiting the amount of hemodilution during cardiopulmonary bypass improves cerebral protection. A prospective, randomized trial in 370 patients will be conducted in which half of the patients will be assigned to moderate hemodilution (hematocrit of greater than or equal to 27%-treatment group) and other half to profound hemodilution (hematocrit 15-18%-current practice group). Change in cognitive function over the first year after surgery will be compared between the groups. A secondary aim is to determine if serum markers of glial (S100beta) and neuronal (neuron-specific enolase) brain injury predict the changes in cognitive function. A positive association of brain injury markers with cognitive change will allow earlier detection and support the hypothesis that the cognitive changes are a result of brain ischemia. New knowledge gained in this study would be immediately transferred to clinical practice and could reduce the severity of cognitive impairment. The new information regarding cerebral protection would also have application in all ischemic brain syndromes including stroke.

越来越多的老年患者接受心脏手术，预计这一趋势将持续下去。这种手术的一个非常常见且令人不安的后果是认知功能恶化。在医院中，这种损伤的比例可能高达 83%，并且有 30% 或更多的患者会持续一年以上。老年患者特别容易受到挽救生命手术的这种神经认知后果的影响。认知功能障碍的原因被认为是心脏手术期间发生的脑栓塞的结果。认知功能障碍的原因被认为是心脏手术期间发生的脑栓塞的结果，这是不可能预防的，因此必须制定保护大脑的策略。在低温心肺转流期间允许血细胞比容有利于血流并担心输血的不良后果已成为心脏手术的标准做法。目前尚不清楚这种血液稀释（血液携氧能力降低 50%）是否会导致脑损伤和认知障碍。我们将检验这样的假设：通过限制体外循环期间的血液稀释量来保持血液的携氧能力可以改善脑保护。将在 370 名患者中进行一项前瞻性随机试验，其中一半患者将被分配至中度血液稀释（血细胞比容大于或等于 27% - 治疗组），另一半患者将被分配至深度血液稀释（血细胞比容 15-18% - 当前实践组）。将比较各组术后第一年认知功能的变化。第二个目的是确定神经胶质（S100β）和神经元（神经元特异性烯醇化酶）脑损伤的血清标志物是否可以预测认知功能的变化。脑损伤标志物与认知变化的正相关性将允许更早检测并支持认知变化是脑缺血结果的假设。这项研究中获得的新知识将立即转移到临床实践中，并可以减轻认知障碍的严重程度。有关脑保护的新信息也适用于包括中风在内的所有缺血性脑综合症。