医学
神经认知
体外循环
围手术期
C反应蛋白
炎症
病理生理学
心脏外科
内科学
麻醉
炎症反应
中枢神经系统
外科
胃肠病学
心脏病学
认知
精神科
作者
Basel Ramlawi,James L. Rudolph,Shigetoshi Mieno,Jun Feng,Munir Boodhwani,Kamal R. Khabbaz,Sue E. Levkoff,Edward R. Marcantonio,Cesario Bianchi,Frank W. Sellke
出处
期刊:Surgery
[Elsevier]
日期:2006-08-01
卷期号:140 (2): 221-226
被引量:94
标识
DOI:10.1016/j.surg.2006.03.007
摘要
It has been recognized that neurocognitive decline (NCD) often occurs as a complication in cardiac surgery. The early inflammatory response and C-reactive protein (CRP) was examined in relation to NCD and to a marker of axonal central nervous system (CNS) injury after cardiopulmonary bypass.A cohort of patients undergoing coronary artery bypass grafting and/or valve procedures using cardiopulmonary bypass were administered a neurocognitive battery preoperatively and postoperatively at 6 hours and day 4. CRP, interleukin 1 beta, and interleukin 10 were quantified from serum. Increase of serum tau protein after surgery was used as a marker of axonal CNS damage.The rate of NCD was found to be 40.5% in this group. Surprisingly, known predictors of NCD did not differ significantly between patients with/without NCD. Patients with NCD had an early increase of CRP of a significantly higher magnitude than those without NCD (38.01 +/- 11.4 vs 16.49 +/- 3.5 mg/L, P = .042), interleukin 1ss (2.35 +/- 0.3 vs 1.20 +/- 0.2 pg/mL, P = .002), and interleukin 10 (29.77 +/- 4.7 vs 12.94 +/- 2.2 pg/mL, P < .001). Increase in serum Tau protein was significantly correlated to NCD (r = 0.50, P = .02).Perioperative increases in CRP and inflammatory cytokines are associated with NCD in patients after cardiopulmonary bypass. Thus, it appears that inflammation plays a key role in NCD pathophysiology, likely via axonal CNS injury, and could become a target for prevention.
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