【罂粟摘要】心脏手术中血压管理对患者长期生存和认知功能的影响：术后随访

心脏手术中血压管理对患者长期生存和认知功能的影响：术后随访

贵州医科大学 高鸿教授课题组

翻译：马艳燕  编辑：佟睿  审校：曹莹

背景

心脏手术与并发症的风险有关，包括术后认知功能障碍(POCD)。在随机灌注压脑梗死(PPCI)试验中，将心脏手术患者分为低目标平均动脉压(40-50 mmHg)组和高目标平均动脉压(70-80 mmHg)组。研究发现，新出现的缺血性脑损伤的体积和POCD没有差异，但高目标平均动脉压组30天死亡率倾向于更高。在本研究中，我们进行了为期3年的长期随访，以评估患者存活率和认知功能水平。最初的假设是，分配到高目标平均动脉压组的患者在3年的随访中有更高的长期死亡率。

方法

我们使用国家登记处对PPCI试验中的患者进行了3年的随访，确定这些患者的长期死亡率，并使用认知测试组合对POCD进行评估。主观功能水平采用问卷调查的方式进行评定。随访时的POCD和主观功能采用Logistic回归模型进行评估。

结果

在参与初始研究的197名患者中，根据体外循环期间的目标血压水平，中位数死亡率在3-4年期间没有统计学意义(风险比1.23(高与低)CI95%：0.50~3.02，P=0.65)。高目标平均动脉压组和低目标平均动脉压组POCD发生率分别为18.9%和14.0%，调整后优势比分别为1.01(CI 95%，0.33~3.12)。不同组间的主观功能没有差异。

结论

根据心脏手术期间的血压目标，在3年的长期随访中，死亡率和认知功能水平没有差异。

原始文献来源：

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 Aug;64(7):936-944.

READING  

Long-term Survival and Cognitive Function According to Blood Pressure Management During Cardiac Surgery. A Follow-up

Background: Cardiac surgery is associated with a risk of complications, including Postoperative Cognitive Dysfunction (POCD). In the randomized Perfusion Pressure Cerebral Infarcts (PPCI) trial, we allocated cardiac surgery patients to either a low-target mean arterial pressure (40-50 mmHg) or a high-target pressure (70-80 mmHg). The study found no difference in the volume of new ischemic cerebral lesions nor POCD, but 30-day mortality tended to be higher in the high-target group. In the present study we did a long-term3-year-follow-up to assess survival and level of cognitive functioning. The primary hypothesis was that patients allocated to a high-target blood pressure had a higher long-term mortality at 3-year-follow-up.

Methods: We determined long-term mortality of patients included in the PPCI trial at 3-year-follow-upusing national registries and we assessed POCD using a cognitive test battery. Subjective level of functioning was assessed with questionnaires. POCD and subjective functioning at follow-up were evaluated in logistic regression models.  

Results: Among the 197 patients who participated in the original study, there was no significant difference in mortality over a median of 3.4 years according to blood pressure target during cardiopulmonary bypass (hazards ratio 1.23 (high vs. low) 95% confidence interval: 0.50 to 3.02, P=0.65). POCD was found in 18.9% and 14.0% in the high-target and low-target groups, respectively adjusted odds ratio1.01 (CI 95% 0.33-3.12). No differences were found for subjective functioning between groups.

Conclusion: No difference in mortality nor in the level of cognitive functioning was found according to blood pressure target during cardiac surgery long-term at 3-year-follow-up.