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首页> 外文期刊>Psychosomatic Medicine: Journal of the American Psychosomatic Society >Preoperative cerebral hypoperfusion in the left, not in the right, hemisphere is associated with cognitive decline after cardiac surgery.
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Preoperative cerebral hypoperfusion in the left, not in the right, hemisphere is associated with cognitive decline after cardiac surgery.

机译：术前左半球而不是右半球的术前脑灌注不足与心脏手术后的认知能力下降有关。

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OBJECTIVE: Postoperative cognitive decline (POCD) is a frequent complication after cardiac surgery. Although intraoperative events are risk factors for POCD, the role played by preoperative hypoperfusion in cognitive decline has not yet been investigated. It is also unknown whether the impact of preoperative hypoperfusion in the left or right middle cerebral arteries (MCAs) can differentially account for POCD. The main aims of this study were to investigate whether preoperative cerebral hypoperfusion was associated with early POCD and whether lateralized hypoperfusion would differentially affect POCD in patients after cardiac surgery. METHODS: Bilateral MCA continuous transcranial Doppler (TCD) sonography was preoperatively performed at rest in 31 right-handed patients who underwent cardiac surgery to detect cerebral blood flow (CBF) velocity. All patients completed a neuropsychological evaluation to assess attention, short-term memory, working memory, and psychomotor function before surgery and at discharge. POCD was defined using the standard deviation method. Logistic regression was used to investigate the association between hypoperfusion and POCD, controlling for common preoperative risk factors. RESULTS: Fourteen patients (45%) exhibited POCD. Cerebral hypoperfusion in the left MCA selectively predicted the incidence of POCD (odds ratio = 0.90, p < .02), whereas CBF velocity in the right MCA was unrelated to POCD (odds ratio = 1.07, p = .39). CONCLUSIONS: Patients who underwent cardiac surgery with reduced CBF velocity in the left MCA preoperatively are at greater risk for POCD. Left cerebral hypoperfusion may also represent an independent predictor of POCD in these patients. TCD evaluation may have substantial clinical benefits for the detection of patients at high risk of POCD after cardiac surgery.
机译：目的：术后认知功能下降（POCD）是心脏手术后的常见并发症。尽管术中事件是POCD的危险因素，但尚未研究术前灌注不足在认知能力下降中的作用。术前灌注不足对左或右大脑中动脉（MCA）的影响是否可以差异性解释POCD也是未知的。这项研究的主要目的是调查心脏手术后患者术前脑灌注不足是否与早期POCD有关，以及侧向灌注不足是否会对POCD产生不同的影响。方法：对31例接受心脏手术的右手患者在休息时进行双侧MCA连续经颅多普勒超声检查（TCD），以检查其脑血流速度。所有患者在手术前和出院时均完成了神经心理学评估，以评估注意力，短期记忆，工作记忆和心理运动功能。 POCD是使用标准偏差方法定义的。 Logistic回归用于研究灌注不足与POCD之间的关联，以控制常见的术前危险因素。结果：14名患者（45％）表现出POCD。左MCA的脑灌注不足选择性地预测了POCD的发生率（几率= 0.90，p <.02），而右MCA的CBF速度与POCD无关（几率= 1.07，p = .39）。结论：术前左MCA进行心脏手术的CBF速度降低的患者发生POCD的风险更高。左脑灌注不足也可能代表这些患者中POCD的独立预测因子。 TCD评估对于心脏手术后POCD高风险患者的检测可能具有重大的临床益处。

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