Aortic manipulation releases embolic material, thereby enhancing the probability of adverse neurologic outcomes following coronary artery bypass grafting (CABG). We prospectively evaluated 59 patients undergoing CABG. Patients in the single (SC, n = 37) and multiple clamp (MC, n = 22) groups were comparable in relation to age and operative risk (p > 0.05). Neurocognitive evaluation consisted of the Auditory Verbal Learning Test (AVLT), Color Trails Test A, the Grooved Pegboard test and the Mini-Mental State Examination. Data acquisition was performed preoperatively, early postoperatively and at the 4-month follow-up. Intraoperative transcranial Doppler (TCD) monitoring was used to quantify the embolic load in relation to different aortic clamping strategies. Preoperative neurocognitive results were similar between the groups (p > 0.05). The incidence of postoperative delirium was greater in the MC group but this failed to reach statistical significance (23% vs 8%, p = 0.14). SC patients had fewer embolization signals (270 ± 181 vs 465 ± 160, p < 0.0001). Early postoperative neurocognitive results were depressed in comparison to preoperative values in both groups (p < 0.05 for multiple comparisons). The magnitude of this cognitive depression was greater in the MC group (p < 0.05 for multiple comparisons). Preoperative levels of neurocognition were restored at follow-up in the SC group in all tests except the AVLT. A trend towards improvements in neurocognitive performances at follow-up was also observed in the MC group. Residual attention, motor skill and memory deficits were, however, documented with multiple tests. In conclusion, the embolic burden was significantly lower in the SC group. This TCD imaging outcome translated into fewer early cognition deficits and superior late restoration of function.

译文

:主动脉操作释放栓塞物质,从而增加冠状动脉搭桥术(CABG)后发生不良神经系统预后的可能性。我们前瞻性评估了59名接受CABG的患者。单组(SC,n = 37)和多钳位(MC,n = 22)组的患者在年龄和手术风险方面具有可比性(p> 0.05)。神经认知评估包括听觉言语学习测验(AVLT),色迹测验A,沟槽式钉板测验和迷你精神状态测验。术前,术后早期以及术后4个月进行数据采集。术中经颅多普勒(TCD)监测用于量化与不同主动脉钳夹策略相关的栓塞负荷。两组之间的术前神经认知结果相似(p> 0.05)。 MC组术后ir妄的发生率较高,但未达到统计学显着性(23%vs 8%,p = 0.14)。 SC患者的栓塞信号较少(270±181 vs 465±160,p <0.0001)。与两组的术前值相比,术后早期的神经认知结果均较低(多重比较,p <0.05)。在MC组中,这种认知抑郁的程度更大(多次比较,p <0.05)。在SC组中,除AVLT以外的所有测试中,术前神经认知水平均得到恢复。 MC组也观察到随访时神经认知能力有改善的趋势。残留的注意力,运动技能和记忆力不足则通过多次测试得到记录。总之,SC组的栓塞负担明显降低。该TCD成像结果可减少较少的早期认知缺陷和晚期功能恢复。

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