在手术上更换大动脉的患者中,与心脏病相关的结构性断裂和妄想
Jeffrey N Browndyke1,2, Lewis E Tomalin3, Guray Erus4
1Division of Behavioral Medicine and Neurosciences, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.
Annals of clinical and translational neurology
|December 29, 2023
概括
大动脉置换后的临床静音脑梗塞与术后妄想有关. Delirium 患者与这些心脏病发作的结构性断开更大,表明他们并非完全沉默.
科学领域:
- 神经学 神经学
- 心血管外科心血管外科
- 神经成像是一种神经成像.
背景情况:
- 急性脑梗塞在进行大动脉置换手术 (SAVR) 后很常见,但往往缺乏临床中风症状.
- 这些之间的联系.
- 这是一个沉默的,无声的世界.
- 心脏病发作和住院妄想是不清楚的,部分原因是传统的心脏病发作的全球指标.
研究的目的:
- 调查心脏病发作位置和相关的结构连接性变化是否与SAVR后的术后狂妄相关.
- 探索隐藏的外科心脏病发作的临床意义.
主要方法:
- 随机SAVR试验 (NCT02389894) 的二次分析,不包括临床中风或不完整的神经成像 (N=298).
- 使用混评估方法进行连续 Delirium 查.
- 神经成像方法 (分片,通道图) 来识别心脏病发作位置和皮质连接效应,使用混合效应模型进行分析.
主要成果:
- 23.5%的参与者出现了术后妄想.
- 妄想与右小脑和白质中较大的心脏病发作量有关.
- 扩散加权成像在额叶和叶中发现了与心脏病发作相关的结构断路 (DWI-ISD);较少的区域显示DWI-ISD损失与基于吸收的神经保护.
结论:
- 在SAVR之后的术后妄与急性脑梗塞的结构性断开有关.
- 这些隐藏性心脏病发作可能比以前假设的更有显著的临床影响.
相关概念视频
Aortic Regurgitation I: Introduction
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
Aneurysm I: Introduction
An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...


