Các biến chứng bệnh học thần kinh đã được tìm thấy xảy ra ở một tỷ lệ bệnh nhân sau CPB. Những vấn đề này cho thấy mình là chức năng nhận thức bị suy giảm, tức là khó khăn với bộ nhớ, tập trung, chú ý, và tốc độ của động cơ và | 78 100 Questions in Cardiology 3 Lytle BW Blackstone EH Loop FD et al. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 1999 117 855-72. 4 Taggart DP. The radial artery as a conduit for coronary artery bypass grafting. Heart 1999 82 409-10. 100 Questions in Cardiology 79 37 How common are neuropsychological complications after cardiopulmonary bypass CPB How predictable and severe are they Can they be prevented Stan Newman and Jan Stygall Neuropsychological complications have been found to occur in a proportion of patients following CPB. These problems reveal themselves as impaired cognitive function . difficulties with memory attention concentration and speed of motor and mental response. However the reported frequency with which these problems occur varies considerably. Studies assessing patients 5-10 days postoperatively have suggested an incidence of neuropsychological deficits ranging from to 90 . Later assessments at about 2 to 6 months after surgery have indicated deficits in 12 to 37 of patients studied. How predictable are they The variation in reported incidence has been ascribed to several factors such as number type sensitivity and timing of neuropsychological tests used as well as the definition of neuropsychological deficit and the method of statistical analysis employed. These methodological issues have been addressed at international consensus conferences in 1994 and 1997. Patient related variables such as age and disease severity have also been associated with cognitive decline post-cardiac surgery. Therefore centres employing different criteria for surgery may report differing rates of deficit. Deficits detected within a few days of surgery are also problematic in that they are often transient in nature. These assessments appear to be contaminated by postoperative readjustment and anaesthetic residue as well as genuine neuropsychological difficulties. Long term deficits over 6 weeks are considered to be more
