AGING AND COGNITION AFTER CARDIAC SURGERY

心脏手术后的衰老和认知

• 批准号: 3121576
• 负责人: JOSEPH G REVES
• 金额: $ 15.22万
• 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 1994-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3121576
• 关键词: aging; cognition disorders; coronary bypass; disease /disorder proneness /risk; human old age (65+); human subject; longitudinal human study; neuropsychological tests; postoperative complications

Elderly patients will increasingly undergo cardiac surgery as the general population of elderly patients with heart disease increases each year. Age is an incremental risk factor for surgical complications in patients who have coronary artery bypass graft (CABG) surgery. Elderly patients appear to be especially at increased risk of suffering cognitive and neuropsychologic dysfunction postoperatively. The mechanism by which this occurs is not known. We propose to test the hypothesis that age-related impairment in cerebral autoregulation causes postoperative cognitive and neuropsychologic dysfunction in cardiac surgical patients. Both types of cerebral autoregulation will be tested: pressure-flow autoregulation and metabolism-flow autoregulation. This is the first prospective study of the postoperative incidence of neuropsychologic dysfunction in the elderly; the incidence of neuropsychologic dysfunction will be determined by neurologic and psychometric testing in 300 CABG patients over three years. The duration of cognitive dysfunction will be determined by serial testing. The hypothesis will be tested using Xe(133) clearance CBF determinations at two different temperatures (i.e., cerebral metabolic conditions) and two different perfusion pressures (i.e., pressure-flow conditions) during cardiopulmonary bypass. Cerebrospinal fluid (CSF) creatine phosphate brain specific isoenzyme and adenylate kinase will be measured at 24 hours after surgery as biochemical markers of ischemic damage postulated to result from impaired autoregulation and inadequate CBF during cardiopulmonary bypass. A comprehensive neuropsychological test battery will be administered on the day prior to surgery and at discharge (7 - 10 days), 6 weeks and 6 months post-CABG. Cardiopulmonary bypass (CPB) is an ideal model for manipulation of cerebral metabolism perfusion pressure and cannot be duplicated in other human experimental settings. Further, CPB is an excellent model for the study of neuropsychologic dysfunction since a relatively high incidence of events can be reproduced. The new knowledge generated in this investigation could lead to implementation of different management principles that could significantly reduce the incidence of this major complication of cardiac surgery in the elderly. Significantly, this will be the first examination in man of the integrity of cerebral blood flow autoregulation of the elderly and will provide new and important information about the physiology of aging.

随着一般情况的发展，老年患者将越来越多地接受心脏手术 老年心脏病患者数量逐年增加。 年龄是患者手术并发症的增加危险因素 接受冠状动脉搭桥术 (CABG) 手术的人。 老年患者 似乎尤其面临更高的认知和认知障碍风险 术后神经心理功能障碍。 其机制 这种情况的发生尚不清楚。 我们建议检验以下假设： 年龄相关的脑自动调节功能障碍导致术后 心脏手术患者的认知和神经心理功能障碍。 将测试两种类型的大脑自动调节：压力-流量 自动调节和代谢流量自动调节。 这是第一个 术后神经心理学发生率的前瞻性研究 老年人功能障碍；神经心理功能障碍的发生率 将通过 300 例 CABG 中的神经学和心理测量测试来确定 三年以上的患者。 认知功能障碍的持续时间将是 通过系列测试确定。 该假设将使用以下方法进行检验 Xe(133) 间隙 CBF 在两个不同温度下的测定（即 脑代谢状况）和两种不同的灌注压 （即，体外循环期间的压力-流量条件）。 脑脊液 (CSF) 磷酸肌酸脑特异性同工酶和 腺苷酸激酶将在手术后 24 小时进行测量，如下所示 缺血性损伤的生化标志物被认为是由受损引起的 体外循环期间的自动调节和 CBF 不足。 一个 全面的神经心理学测试电池将在 手术前一天和出院时（7 - 10 天）、6 周和 6 个月 冠状动脉搭桥术后。 体外循环（CPB）是一种理想的模型 脑代谢灌注压的操纵不能 在其他人体实验环境中重复。 此外，CPB 是 自古以来研究神经心理功能障碍的优秀模型 可以再现发生率相对较高的事件。 新知识 本次调查中产生的结果可能会导致实施不同的 可以显着降低发生率的管理原则 这是老年人心脏手术的主要并发症。 值得注意的是，这将是对正直人的第一次考验 老年人脑血流自动调节的研究将为老年人提供新的 以及有关衰老生理学的重要信息。