Estradiol For Neurocognitive Dysfunction After CABG

与男性相比，接受冠状动脉旁路移植术（CABG）的女性手术死亡率更高，住院时间更长，住院费用更高。女性手术的高发病率和死亡率很大一部分是由于围手术期神经损伤。在各种体外和动物实验中风模型中，雌激素一直被证明可以降低神经损伤的程度。这些数据共同有力地表明，老年妇女围手术期神经系统并发症的风险较高，可能与其雌激素缺乏状态。在这项随机、安慰剂对照研究中，我们将检验绝经后妇女围手术期雌激素替代治疗降低CABG术后神经系统损伤风险的假设。334名接受CABG手术的女性将前瞻性随机接受17 β-雌二醇或安慰剂，从手术前一天开始，以双盲方式进行，并持续手术后5天。将评估患者的神经认知功能障碍，这是心脏手术神经损伤的最常见表现。将在术前1-2天、术后4 - 6周和术后6个月进行神经认知测试。主要终点是围手术期接受17 β-雌二醇的妇女与安慰剂相比术后4 - 6周的神经认知功能。我们还将评估术后认知功能下降对术后6个月认知功能和生活质量指标的重要性，以及围手术期17 β-雌二醇治疗是否改善了后者的结局。本研究的结果将评价一种易于实施的治疗方法在改善绝经后女性CABG术后神经功能结局和生活质量方面的疗效和安全性。

Women undergoing coronary artery bypass graft (CABG) surgery have a higher operative mortality rate, longer hospitalizations, and higher hospital cost compared with men. A large proportion of this excess morbidity and mortality of surgery for women is due to perioperative neurologic injury. Estrogens have been consistently shown to reduce the extent of neurologic injury in a variety of in vitro and animal experimental stroke models. These data together strongly suggest that the higher risk for perioperative neurologic complications for elderly women may relate to their estrogen deficient state. In this randomized, placebo controlled study, we will test the hypothesis that perioperative estrogen replacement in postmenopausal women reduces the risk for neurologic injury after CABG surgery. Three hundred thirty four women undergoing CABG surgery will be prospectively randomized to receive either 17beta-estradiol or placebo in a double-blind fashion beginning the day before surgery and continued for 5 days after surgery. Patients will be assessed for neurocognitive dysfunction, the most common manifestation of neurologic injury from cardiac surgery. Neurocognitive testing will be performed 1-2 days before surgery, 4 to 6 weeks postoperatively, and 6- months after surgery. The primary endpoint will be neurocognitive function 4 to 6 weeks after surgery for women who received 17beta- estradiol compared with placebo perioperatively. We will also evaluate for the importance of postoperative cognitive decline on measures of cognitive function and quality of life 6 months after surgery and whether perioperative 17beta-estradiol treatment improves these latter outcomes. The results of this study will evaluate the efficacy and safety of an easily implemented therapy for improving neurologic outcome and quality of life after CABG surgery for postmenopausal women.