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

[21]

Vaughn CC, Opie JC, Florendo FT, Et al., Warm blood cardioplegia, Ann Thorac Surg, 55, pp. 1227-1232, (1993)

[22]

Calafiore AM, Giovanni T, Mezzetti A, Et al., Intermittent antegrade warm blood cardioplegia, Ann Thorac Surg, 59, pp. 398-402, (1995)

[23]

Singh AK, Feng WC, Bert AA, Et al., Warm body, cold heart surgery: Clinical experience in 2,817 patients, Eur J Cardiothorac Surg, 7, pp. 225-230, (1993)

[24]

Ridenour TR, Warner DS, Todd MM, Et al., Mild hypothermia reduces infarct size resulting from temporary but not permanent focal ischemia in rats, Stroke, 23, pp. 733-738, (1982)

[25]

Blair E, Generalized hypothermia, Fed Proc, 28, pp. 1456-1462, (1969)

[26]

Loop FD, Higgins TL, Panda R, Et al., Myocardial protection during cardiac operations, J Thorac Cardiovasc Surg, 104, pp. 608-618, (1992)

[27]

Ikonomidis JS, Yau TM, Weisel RD, Et al., Optimal flow rates for retrograde warm cardioplegia, J Thorac Cardiovasc Surg, 107, pp. 510-519, (1994)

[28]

Lajos TZ, Espersen CC, Lajos PS, Et al., Comparison of cold versus warm cardioplegia: Crystalloid antegrade or retrograde blood, Circulation, 88, pp. 344-349, (1993)

[29]

Mellitt RJ, Weintraub WS, Craver JM, Et al., The interrelationship of age and normothermic blood versus cold crystalloid cardioplegia on the incidence of stroke in elective coronary artery bypass grafting: Results of the Emory randomized trial, Circulation, 88, 4, pp. 1-288, (1993)

[30]

Fransco P, Croughwell N, Blumenthal J, Et al., Association between blood glucose level during cardiopulmonary bypass and neuropsychiatric outcome, Anesthesiology, 75, 3 A, (1991)

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