心脏手术后神经系统并发症的评估与管理
Prevention and treatment for neurological complications after cardiac surgery
- 解放军医学杂志 2023年48卷第11期 页码：1287-1293
- 作者机构：
1.空军军医大学西京医院麻醉与围术期医学科，陕西西安 710032
- 作者简介：
李雨濛，硕士研究生，主要从事围手术期神经保护相关的研究
聂煌，E-mail：niehuang@163.com
- 基金信息：
DOI：10.11855/j.issn.0577-7402.2061.2023.0601
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李雨濛, 郭海云, 张震, 等. 心脏手术后神经系统并发症的评估与管理[J]. 解放军医学杂志, 2023, 48(11): 1287-1293.
Li Yu-Meng,Guo Hai-Yun,Zhang Zhen,et al.Prevention and treatment for neurological complications after cardiac surgery[J].Medical Journal of Chinese People′s Liberation Army,2023,48(11):1287-1293.
李雨濛, 郭海云, 张震, 等. 心脏手术后神经系统并发症的评估与管理[J]. 解放军医学杂志, 2023, 48(11): 1287-1293. DOI： 10.11855/j.issn.0577-7402.2061.2023.0601.
Li Yu-Meng,Guo Hai-Yun,Zhang Zhen,et al.Prevention and treatment for neurological complications after cardiac surgery[J].Medical Journal of Chinese People′s Liberation Army,2023,48(11):1287-1293. DOI： 10.11855/j.issn.0577-7402.2061.2023.0601.
摘要
卒中、认知功能障碍和谵妄等形式的神经系统损伤是心脏手术后的常见并发症，也是导致心脏手术患者术后死亡和长期致残的主要原因。目前有许多研究尝试确定干预和治疗策略，但尚未形成标准化的神经功能保护方案。本文旨在讨论心脏手术后神经损伤的风险因素、机制和改善患者预后的神经保护措施，阐述近期从术前评估和干预、术中管理和监测，以及术后并发症的诊断和治疗的研究进展，强调围手术期防治重点应以预防缺血缺氧性损伤为主。未来研究方向应侧重于临床前实验的转化研究及新型成像技术的开发，以降低神经系统并发症的发生率，改善预后。
Abstract
Neurological impairment in the form of stroke, cognitive dysfunction and delirium is a common complication after cardiac surgery and a major cause of postoperative death and long-term disability in patients undergoing cardiac surgery. There have been many studies attempting to identify intervention and treatment strategies, but no standardized protocols for neurological protection have been developed. The purpose of this article is to discuss the risk factors, mechanisms and neuroprotective measures to improve patient prognosis of neurological injury after cardiac surgery, and to review the recent research progress from three aspects: preoperative assessment and intervention, intraoperative management and monitoring, and postoperative diagnosis and treatment, emphasizing that the focus of perioperative prevention and treatment should be on the prevention of ischemic-hypoxic injury. Future research directions should focus on translational research of preclinical experiments and the development of novel imaging techniques to reduce the incidence of neurological complications and improve clinical outcome.
关键词
心脏外科手术神经系统并发症神经保护围手术期
Keywords
cardiac surgeryneurological complicationneuroprotectionperioperative period
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