体外循环心脏手术后患者精神障碍的发生机制

Mechanism of mental disorders after cardiopulmonary bypass

目的:精神障碍是体外循环心脏手术后主要并发症之一,近年来引起人们的高度关注,但其发病机制仍不清楚。资料来源:应用计算机检索Medline1990-01/2003-12关于体外循环心脏手术后精神障碍的文章,检索词包括Cardiopulmonarybypass;Mentaldisorder;Confusion;Cognitivedysfunction;Delirium;Braininjury等,并限定文章语言种类为English。资料选择:选择与体外循环术中脑氧代谢变化、术后精神状态、认知功能以及脑损伤相关的文章。纳入标准:详细阐述体外循环术后精神障碍发生机制的文献。排除标准:重复性研究。资料提炼:共收集到134篇关于体外循环心脏手术后精神障碍的文献,涉及术后精神和认知变化的78篇,体外循环术中脑氧代谢变化的32篇,体外循环引起脑损伤的24篇,排除108篇,纳入26篇用于综述。资料综合:体外循环术后精神障碍发生的危险因素包括高龄、术前合并高血压和/或糖尿病、脑血管疾病、主动脉粥样硬化等,体外循环期间脑氧代谢变化、神经递质变化、脑损伤以及相关基因等可能与体外循环术后精神障碍的发生机制有关。结论:体外循环术后精神障碍的发生机制非常复杂,是多种因素共同作用的结果。但要完全了解其发生机制还需临床和基础的进一步研究。

OBJECTIVE： Mental disorder is a common complication after cardiac surgeries with cardiopulmonary bypass, and it has attracted great attention in recent years, but the exact mechanism is still unknown. DATA SOURCES： An overall retrieval for materials on mental disorders after cardiopalmonary bypass between January 1990 and December 2003 on Pubmed by using the keywords of ＂cardiopulmonary bypass, mental disorder, confusion, cognitive dysfunction, delirium and brain injury＂ in English. STUDY SELECTION： Articles related to cerebral metabolism abnormality, mental states changes, cognitive dysfunction and brain injuries were chosen. Inclusive criteria： studies related to the mechanism of postoperative mental disorders after cardiopulmonary bypass. Exclusive criteria： repetitive studies. DATA EXTRACTION： Tot.ally 134 materials involved postoperative mental disorders after cardiopulmonary bypass, 78 of which involved mental and cognitive changes, 32 involved cerebral metabolism abnormality, and 24 involved brain injuries, 108 were excluded. And 26 documents were accepted. DATA SYNTHESIS： The risk factors for the mental disorders after cardiopulmonary bypass were aging, preoperative complication of hypertension and/or diabetes mellitus, cerebrovascular diseases, aortic atherosclerosis, etc. The changes of cerebral metabolism, changes of neurotransmitter, brain injuries and related genes may be involved in the pathogenesis of mental disorders after cardiopulmonary bypass CONCLUSION： The mechanism of mental disorders after cardiopulmonary bypass is very complex, which involves multiple factors, and completely understanding the mechanism needs the further studies in clinical and basic researches.