NEUROLOGICAL OUTCOMES AND CARDIOPULMONARY TEMPERATURE - A CLINICAL REVIEW

被引：12

作者：

CHRISTAKIS, GT ^{[1
]}

ABEL, JG ^{[1
]}

LICHTENSTEIN, SV ^{[1
]}

机构：

[1] ST PAULS HOSP,CTR HEART,DIV CARDIOVASC & THORAC SURG,VANCOUVER,BC V6Z 1Y6,CANADA

来源：

JOURNAL OF CARDIAC SURGERY | 1995年 / 10卷 / 04期

关键词：

D O I：

10.1111/j.1540-8191.1995.tb00680.x

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

All available controlled studies of warm versus cold and antegrade versus retrograde delivery of cardioplegia were reviewed to assess the incidence of perioperative stroke and adverse neuropsychological outcomes. Nine randomized trials and substudies and two studies with immediate historical consecutive controls reported neurological outcomes and were described as warm versus cold. Pooled event rates for perioperative stroke were 1.5% for warm antegrade, 3.14% for warm retrograde, 1.7% for cold antegrade, and 0% to 1.2% for cold retrograde. Examining within trial differences, only one study showed a significant disadvantage to warm 4.5% versus cold 1.4% on incidence of perioperative stroke, but the design does not permit determination of whether the difference is due to systemic temperature, retrograde coronary perfusion, or other factors. Furthermore, if only warm (> 33 degrees C) versus cold (< 30 degrees C) systemic perfusion is examined in all studies for the incidence of stroke irrespective of cardioplegia temperature or antegrade versus retrograde coronary perfusion (warm 2.1%; cold 1.6%), the above study remains a significant outlier. This suggests that the differences found are unlikely to be due to temperature but may be related to antegrade versus retrograde coronary perfusion. Review of randomized trials evaluating neuropsychological function post-cardiopulmonary bypass (post-CPB) also failed to reveal any advantage related to temperature of systemic perfusion. Since manipulations that are most likely to give rise to cerebral embolization are uniformly carried out at normothermia at the beginning and end of the operation, it is not entirely unexpected that the incidence of neurological events was found to be independent of the temperature of CPB. Because stroke is both too rare and too variable in magnitude by chance alone, no studies to date have adequately assessed stroke severity in relation to systemic perfusion temperature or mode and route of cardioplegia delivery.

引用

页码：475 / 480

页数：6

共 34 条

[1]

Breuer AC, Furlan AJ, Hanson MR, Et al., Central nervous system complications of coronary artery bypass, Stroke, 14, pp. 683-685, (1983)

[2]

Gilman SD, Neurological complications of open heart surgery, Ann Neurol, 28, pp. 475-477, (1990)

[3]

Javid H, Tufo HM, Hunter IA, Neurologic abnormalities following open heart surgery, J Thorac Cardiovasc Surg, 58, pp. 502-507, (1969)

[4]

Hammeke TA, Hastings JE, Neuropsychologic alterations after cardiac operation, J Thorac Cardiovasc Surg, 96, pp. 326-331, (1988)

[5]

Lichtenstein SV, El Dalati H, Panos A, Et al., Long cross‐clamp times with warm heart surgery, Lancet, 1, (1989)

[6]

Wong BI, McLean RF, Naylor CD, Et al., Central nervous system dysfunction after warm or hypothermic cardiopulmonary bypass, Lancet, 339, pp. 1383-1384, (1992)

[7]

McLean RF, Wong BI, Naylor CD, Et al., Cardiopulmonary bypass, temperature and central nervous system dysfunction, Circulation, 90, pp. 250-255, (1994)

[8]

Randomized trial of normothermic versus hypothermic coronary bypass surgery, Lancet, 343, pp. 559-563, (1994)

[9]

Pelletier LC, Carrier M, Leclerc Y, Et al., Intermittent antegrade warm versus cold blood cardioplegia: A prospective randomized study, Ann Thorac Surg, 58, pp. 41-49, (1994)

[10]

Martin TD, Craver JM, Gott JP, Et al., Prospective randomized trial of retrograde warm blood cardioplegia: Myocardial benefit and neurologic threat, Ann Thorac Surg, 57, pp. 298-304, (1994)

← 1 2 3 4 →