脑血液动力学变化和手术后大脑功能在接受心肺旁路心脏门手术的患者:一个前性队列研究
Changxue Wu1, Zhi Wen1, Zheng Wang1
1Department of Cardiothoracic Vascular Surgery, Deyang People's Hospital, Deyang, CHN.
Cureus
|October 2, 2025
概括
在心脏手术期间进行的跨骨多普勒 (TCD) 监测显示,手术内大脑输液和更长的心肺旁路 (CPB) 时间预测了手术后妄想. 手术后无法恢复大脑血液流动与妄想的发展有关.
科学领域:
- 神经学 神经学
- 心血管外科心血管外科
- 医疗成像医学成像
背景情况:
- 心脏手术中的心肺绕道 (CPB) 可以破坏大脑血液动力学,增加术后神经并发症的风险,如妄想.
- 跨骨多普勒 (TCD) 是监测大脑血流的非侵入性工具,但其对心脏手术后痴呆症的预测价值尚未得到充分确立.
研究的目的:
- 通过TCD监测的手术内大脑血动力学变化与手术后痴呆症发生在接受CPB心脏门手术的患者之间的关联.
主要方法:
- 一项前性队列研究包括了184名接受心脏门选择性手术的患者.
- TCD测量了中脑动脉的平均流速 (Vm),脉动性指数 (PI) 和阻力指数 (RI) 在多个外科手术时间点.
- 使用ICU (CAM-ICU) 的困惑评估方法进行了术后妄的评估.
主要成果:
- 术后妄想发生在10.9%的患者中,与较长的CPB和大动脉十字时间有关.
- 与没有 Delirium 的患者相比,患有 Delirium 的患者表现出更严重的手术后大脑输液下降 (减少 Vm,增加 PI 和 RI).
- 狂妄症患者在术后表现出持续的血液动力学异常和显著的认知衰退,与非狂妄症组不同.
结论:
- 通过TCD检测到的手术内大脑低输液和长时间的CPB持续时间是术后妄想的独立预测因素.
- 手术后大脑血液动力学恢复受损可能在 Delirium 的发展中起作用.
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