心脏主动脉瓣置换术后脑功能障碍

N. V. Tsygan, A. V. Ryabtsev, R. V. Andreev, K. Sapozhnikov, A. Peleshok, M. Odinak, I. Litvinenko
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引用次数: 2

摘要

研究目的:研究开放主动脉瓣置换术及血管内主动脉瓣置换术后脑功能障碍的发生率及结构,探讨开放主动脉瓣置换术后脑功能障碍的危险因素及预防方法。研究设计:前瞻性队列研究。材料与方法。该研究涉及114例患者(男性92例,女性22例),年龄67岁[58;[76],接受择期主动脉瓣置换术。所有患者分为三组:开放手术组(n = 82)、脑保护组(n = 16)和x线手术组(n = 16)。在“开放手术”组和“脑保护”组中,患者行体外循环开放主动脉瓣置换术,在“x线手术”组中,患者行经导管主动脉瓣植入术。“脑保护”组患者术后早期加用1.5%琥珀酸甲胺钠溶液。研究的结果。41.2%的患者被诊断为术后脑功能障碍,两组患者术后脑功能障碍发生率无差异。脑保护组术后早期症状性谵妄持续时间较开放组短(p = 0.0441)。我们确定了18个术后脑功能障碍的危险因素及其临床类型,以及2个脑保护因素——体重指数大于25 kg/m2和术后早期使用琥珀酸甲氨胺钠。结论。主动脉瓣置换术术后脑功能障碍发生率高,围手术期脑保护方法有待进一步改进。关键词:术后脑功能障碍,围手术期卒中,术后早期症状性谵妄,术后认知功能障碍,围手术期脑保护,主动脉瓣置换术
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Postoperative Cerebral Dysfunction in Cardiac Aortic Valve Replacement
Study Objective: To study the incidence and the structure of the postoperative cerebral dysfunction after open and endovascular aortic valve replacement surgery, and to identify the risk factors and the methods of prevention of postoperative cerebral dysfunction after the open aortic valve replacement surgery. Study Design: Prospective cohort study. Materials and Methods. The study involved 114 patients (92 men and 22 women) aged 67 [58; 76] years, who undergone elective aortic valve replacement surgery. All patients were divided into three groups: “open surgery” (n = 82), “cerebroprotection” (n = 16) and “X-ray surgery” (n = 16). In the “open surgery” and “cerebroprotection” groups, patients undergo open aortic valve replacement surgery with cardiopulmonary bypass, in the “X-ray surgery” group transcatheter aortic valve implantation is performed. In the “cerebroprotection” group patients additionally received the 1.5% solution of meglumine sodium succinate in the early postoperative period. Study Results. The postoperative cerebral dysfunction was diagnosed in 41.2% of patients, the incidence of the postoperative cerebral dysfunction did not differ in the study groups. In the group “cerebroprotection” there was a shorter duration of symptomatic delirium of the early postoperative period (p = 0.0441) compared with the group “open surgery”. We identified 18 risk factors for postoperative cerebral dysfunction and its clinical types and two cerebroprotective factors — a body mass index more than 25 kg/m2 and the use of the meglumine sodium succinate in the early postoperative period. Conclusion. Aortic valve replacement surgery is characterized by the high incidence of the postoperative cerebral dysfunction, further improvement of the methods of the perioperative cerebroprotection is required. Keywords: postoperative cerebral dysfunction, perioperative stroke, symptomatic delirium of the early postoperative period, postoperative cognitive dysfunction, perioperative cerebroprotection, aortic valve replacement.
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