Kardiyak Cerrahi Sonrası Postoperatif Bilişsel Fonksiyon Bozukluğu; Görülme sıklığı ve Risk Faktörleri

Year 2024, , 74 - 83, 29.02.2024

Tülay Çardaközü , Zeki Talas , Nur Nazire Yucal , Sibel Gur , Huri Yeşildal , Şadan Yavuz

https://doi.org/10.53446/actamednicomedia.1370258

Abstract

Öz
Kardiyak Cerrahi Sonrası Postoperatif Bilişsel Fonksiyon Bozukluğu; Görülme sıklığı ve Risk Faktörleri
Amaç:
Çalışmamızın amacı merkezimizde kalp cerrahisi sonrası kognitif bozulma görülme sıklığını ve risk faktörlerini araştırmaktır.
Yöntem:
01-01-2021 ve 31-12-2021 tarihleri arasında kalp cerrahisi planlanan 18-70 yaş arası ASA II-III hastaları çalışmaya dahil edildi. Ameliyat sonrası bilişsel bozukluk (POBB) tanısı mini mental durum testi (MMDT) ile konuldu. MMDT ameliyat öncesi ve ameliyat sonrası 7. gün ve 8. haftada yapıldı.
MMDT puanı <23 olan hastalar bilişsel işlev bozukluğu olan POBB (+) olarak tanımlandı.
Bulgular:
Bu süre içerisinde uygun görülen 231 hastadan 73'ü çalışma dışı bırakıldı, çalışmaya dahil edilen 158 hastadan 54'ü çalışmayı tamamlayamadı ve geri kalan 104 hastanın verileri analiz edildi. POBB (+) görülme sıklığı 7. günde %38,46, ameliyat sonrası 8. haftada ise %22,11 olarak belirlendi. Yaş, ameliyat öncesi MMDT skorunun düşük olması, ameliyat öncesi Euroscore skorunun yüksek olması, 7. günde yoğun bakımda kalış süresinin uzun olması, yaş, ameliyat öncesi ve ameliyat sonrası 7. günde MMDT skorunun düşük olması 8. hafta için POBB risk faktörleri olarak belirlendi.
Sonuç:
Kalp cerrahisi sonrası POBB hala ciddi bir sorundur ve bunu en aza indirmek için risk faktörlerinin bilinmesi önemlidir.

Keywords

Kalp Cerrahisi, Ameliyat Sonrası Bilişsel Bozukluk, Mini Mental Durum Testi

References

• Berger M, Nadler JW, Browndyke J, et al. Postoperative cognitive dysfunction: minding the gaps in our knowledge of a common postoperative complication in the elderly. Anesthesiol Clin. 2015;33(3):517-550. doi:10.1016/j.anclin.2015.05.008
• Norkienė I, Samalavičius R, Misiūrienė I, Paulauskienė K, Budrys V, Ivaškevičius J. Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting. Medicina (Mex). 2010;46(7):460. doi:10.3390/medicina46070066
• Relander K, Hietanen M, Rantanen K, et al. Postoperative cognitive change after cardiac surgery predicts long-term cognitive outcome. Brain Behav. 2020;10(9):e01750. doi:10.1002/brb3.1750
• Newman MF, Kirchner JL, Phillips-Bute B, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344(6):395-402. doi:10.1056/NEJM200102083440601
• Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. The Lancet. 1998;351(9106):857-861. doi:10.1016/s0140-6736(97)07382-0
• Sidebotham D. Cardiothoracic Critical Care. Elsevier Health Sciences; 2007.
• Greaves D, Psaltis PJ, Davis DH, et al. Risk factors for delirium and cognitive decline following coronary artery bypass grafting surgery: a systematic review and meta-analysis. J Am Heart Assoc. 2020;9(22):e017275. doi:10.1161/JAHA.120.017275
• Berian JR, Zhou L, Russell MM, et al. Postoperative delirium as a target for surgical quality improvement. Ann Surg. 2018;268(1):93-99. doi:10.1097/SLA.0000000000002436
• Van Harten AE, Scheeren TWL, Absalom AR. A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia. Anaesthesia. 2012;67(3):280-293. doi:10.1111/j.1365-2044.2011.07008.x
• Gazioğlu TG, Karadeniz Ü, Demir ZA, et al. Açık kalp cerrahisinde kapak ve koroner ameliyatlarında serebral oksijenasyon monitörizasyonu. Göğüs Kalp Damar Anestezi ve Yoğun Bakım Derneği Derg. 2017;23(1):8-14. doi:10.5222/GKDAD.2017.008
• Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198. doi:10.1016/0022-3956(75)90026-6
• Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Standardize mini mental test’in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Türk Psikiyatri Derg. 2002;13(4):273-281.
• Selnes OA, Gottesman RF, Grega MA, Baumgartner WA, Zeger SL, McKhann GM. Cognitive and neurologic outcomes after coronary-artery bypass surgery. N Engl J Med. 2012;366(3):250-257. doi:10.1056/NEJMra1100109
• Kok WF, Van Harten AE, Koene B, et al. A pilot study of cerebral tissue oxygenation and postoperative cognitive dysfunction among patients undergoing coronary artery bypass grafting randomised to surgery with or without cardiopulmonary bypass. Anaesthesia. 2014;69(6):613-622. doi:10.1111/anae.12634
• Rasmussen LS, Larsen K, Houx P, et al. The assessment of postoperative cognitive function. Acta Anaesthesiol Scand. 2001;45(3):275-289. doi:10.1034/j.1399-6576.2001.045003275.x
• Mahanna EP, Blumenthal JA, White WD, et al. Defining neuropsychological dysfunction after coronary artery bypass grafting. Ann Thorac Surg. 1996;61(5):1342-1347. doi:10.1016/0003-4975(95)01095-5
• Van Dijk D, Jansen EW, Hijman R, et al. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. Jama. 2002;287(11):1405-1412. doi:10.1001/jama.287.11.1405
• Lamont RA, Swift HJ, Drury L. Understanding perceived age-based judgement as a precursor to age-based stereotype threat in everyday settings. Front Psychol. 2021;12:640567. doi:10.3389/fpsyg.2021.640567
• Thames AD. Conducting a culturally informed neuropsychological evaluation. Archives of Clinical Neuropsychology. 2018;33(2):254-256. doi:10.1093/arclin/acx057
• De Marchis GM, Foderaro G, Jemora J, et al. Mild cognitive impairment in medical inpatients: the Mini-Mental State Examination is a promising screening tool. Dement Geriatr Cogn Disord. 2010;29(3):259-264. doi:10.1159/000288772
• Ballard C, Jones E, Gauge N, et al. Optimised anaesthesia to reduce post operative cognitive decline (POCD) in older patients undergoing elective surgery, a randomised controlled trial. PloS One. 2012;7(6):e37410. doi:10.1371/journal.pone.0037410
• Monk TG, Weldon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery. J Am Soc Anesthesiol. 2008;108(1):18-30. doi:10.1097/01.anes.0000296071.19434.1e
• Caldas JR, Haunton VJ, Panerai RB, Hajjar LA, Robinson TG. Cerebral autoregulation in cardiopulmonary bypass surgery: a systematic review. Interact Cardiovasc Thorac Surg. 2018;26(3):494-503. doi:10.1093/icvts/ivx357
• Glas KE, Swaminathan M, Reeves ST, et al. Guidelines for the performance of a comprehensive intraoperative epiaortic ultrasonographic examination: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists; endorsed by the Society of Thoracic Surgeons. J Am Soc Echocardiogr. 2007;20(11):1227-1235. doi:10.1016/j.echo.2007.09.001
• Marasco SF, Sharwood LN, Abramson MJ. No improvement in neurocognitive outcomes after off-pump versus on-pump coronary revascularisation: a meta-analysis. Eur J Cardiothorac Surg. 2008;33(6):961-970. doi:10.1016/j.ejcts.2008.03.022
• Møller CH, Perko MJ, Lund JT, et al. No major differences in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass surgery: the best bypass surgery trial. Circulation. 2010;121(4):498-504. doi:10.1161/CIRCULATIONAHA.109.880443
• Aykut K, Albayrak G, Guzeloglu M, Hazan E, Tufekci M, Erdoğan I. Pulsatile versus non-pulsatile flow to reduce cognitive decline after coronary artery bypass surgery: a randomized prospective clinical trial. J Cardiovasc Dis Res. 2013;4(2):127-129. doi:10.1016/j.jcdr.2013.05.005
• O’Neil MP, Fleming JC, Badhwar A, Guo LR. Pulsatile versus nonpulsatile flow during cardiopulmonary bypass: microcirculatory and systemic effects. Ann Thorac Surg. 2012;94(6):2046-2053. doi:10.1016/j.athoracsur.2012.05.065
• Ono M, Joshi B, Brady K, et al. Risks for impaired cerebral autoregulation during cardiopulmonary bypass and postoperative stroke. Br J Anaesth. 2012;109(3):391-398. doi:10.1093/bja/aes148
• Nomura Y, Faegle R, Hori D, et al. Cerebral small vessel, but not large vessel disease, is associated with impaired cerebral autoregulation during cardiopulmonary bypass: a retrospective cohort study. Anesth Analg. 2018;127(6):1314-1322. doi:10.1213/ANE.0000000000003384
• Henriksen L, Hjelms E, Lindeburgh T. Brain hyperperfusion during cardiac operations: cerebral blood flow measured in man by intra-arterial injection of xenon 133: evidence suggestive of intraoperative microembolism. J Thorac Cardiovasc Surg. 1983;86(2):202-208.
• Larsen MH, Draegert C, Vedel AG, et al. Long-term survival and cognitive function according to blood pressure management during cardiac surgery. A follow-up. Acta Anaesthesiol Scand. 2020;64(7):936-944. doi:10.1111/aas.13595
• Joshi B, Ono M, Brown C, et al. Predicting the limits of cerebral autoregulation during cardiopulmonary bypass. Anesth Analg. 2012;114(3):503-510. doi:10.1213/ANE.0b013e31823d292a
• Brady K, Joshi B, Zweifel C, et al. Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. Stroke. 2010;41(9):1951-1956. doi:10.1161/STROKEAHA.109.575159
• Colak Z, Borojevic M, Bogovic A, Ivancan V, Biocina B, Majeric-Kogler V. Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after coronary artery bypass surgery: a randomized, prospective study. Eur J Cardiothorac Surg. 2015;47(3):447-454. doi:10.1093/ejcts/ezu193
• Liu T, Deng R, Wang X, et al. Mechanisms of hypoxia in the hippocampal CA3 region in postoperative cognitive dysfunction after cardiopulmonary bypass. J Cardiothorac Surg. 2022;17(1):1-11. doi:10.1186/s13019-022-01865-z
• Onur T, Karaca Ü, Ata F, et al. Intraoperative hyperoxygenation may negatively affect postoperative cognitive functions in coronary artery bypass graft operations: A randomized controlled study. J Card Surg. 2022;37(9):2552-2563. doi:10.1111/jocs.16661
• Berger M, Browndyke J, Mathew JP. Intraoperative glycemic control to prevent delirium after cardiac surgery: steering a course between Scylla and Charybdis. Anesthesiology. 2015;122(6):1186-1188. doi:10.1097/ALN.0000000000000670
• Puskas F, Grocott HP, White WD, Mathew JP, Newman MF, Bar-Yosef S. Intraoperative hyperglycemia and cognitive decline after CABG. Ann Thorac Surg. 2007;84(5):1467-1473. doi:10.1016/j.athoracsur.2007.06.023
• Mathew JP, Mackensen GB, Phillips-Bute B, et al. Effects of extreme hemodilution during cardiac surgery on cognitive function in the elderly. J Am Soc Anesthesiol. 2007;107(4):577-584. doi:10.1097/01.anes.0000281896.07256.71
• Schifilliti D, Grasso G, Conti A, Fodale V. Anaesthetic-related neuroprotection: intravenous or inhalational agents? CNS Drugs. 2010;24(11):893-907. doi:10.2165/11584760-000000000-00000
• Bocskai T, Kovács M, Szakács Z, et al. Is the bispectral index monitoring protective against postoperative cognitive decline? A systematic review with meta-analysis. PLoS One. 2020;15(2):e0229018. doi:10.1371/journal.pone.0229018