成人心脏外科术后脑损伤诊治的中国专家共识

背景：脑损伤作为成人心脏外科术后一种严重的并发症，发病率依然较高，是除心功能不全以外导致心脏外科手术患者预后不良的最主要因素之一。

目的：为减少心脏外科手术后脑卒中并发症，建立相关方面的诊治规范。

方法：为了降低成人心脏外科术后脑损伤的发生率，减少神经系统并发症，中国研究型医院学会神经再生与修复专业委员会心脏重症脑保护学组联合神经重症护理与康复学组，组织国内心脏内外科、神经内外科、重症监护、体外循环、麻醉以及急诊等医学专家，参考国内外相关指南，结合中国的实际情况，从成人心脏外科术后脑损伤的表现形式、危险因素、非药物性保护策略、术中神经监测以及药物性保护策略等方面，旨在促进患者脑神经功能康复角度进行撰写，经多次讨论最终成稿，制定该专家共识，以期指导临床工作。结果与结论：为了降低成人心脏手术后脑损伤的发生率，减少神经系统并发症，需要采用个性化、以患者为中心的方法来管理那些可改变的脑损伤危险因素，采用包括术中栓塞的预防，血压、血糖、体温的管理，以及针对术后神经炎性反应药物治疗等方法，达到改善手术效果、提高患者生活质量的目的。然而，目前仍需要进一步的研究，尤其是高质量的以结果为导向的随机对照试验，以进一步提高脑损伤处理策略的证据支持。

BACKGROUND: Brain injury, as a serious complication of adult cardiac surgery, has an increasing incidence, which is one of the most important factors leading to poor prognosis in cardiac surgery patients except for heart failure.

OBJECTIVE: To establish the relevant standards for the diagnosis and treatment of postoperative complications so as to reduce the neurological complications, such as stroke, after cardiac surgery in adults.

METHODS: To decrease the incidence of brain injury and reduce the neurological complications after cardiac surgery in adults, experts from cardiology and cardiosurgery, neurology and neurosurgery, intensive care unit, cardiopulmonary bypass, anesthesia and emergency have been organized to write the consensus by Cardiac Intensive Brain Care Group and Neurocritical Care and Rehabilitation Group which is belonging to the Neural Regeneration and Repair Committee of Chinese Association of Research Hospitals. Relevant domestic and foreign guidelines have been referred to, and also combined with the actual situation in China. The consensus was written based on manifestation, risk factors, non-drug protection strategies, intraoperativeneuromonitoring, and drug protection strategies. The writing purpose of this consensus is to promote the rehabilitation of patients' cerebral nerve function. During this period, the draft has been discussed many times by the writing team before the final edition. We hope that it will be helpful to guide the clinical practice.

RESULTS AND CONCLUSION: To reduce the incidence of brain injuries and neurological complications after cardiac surgery in adults, several personalized, patient-centric approaches are needed to manage those risk factors for alterable brain injury, including the prevention of intraoperative embolism, management of blood pressure, blood sugar and body temperature, and drug treatment for postoperative neuro-inflammatory reactions, with the aim of improving surgical effect and patients’ quality of life. However, high-quality, results-oriented, randomized controlled trials to further provide evidence for management strategies of brain injury are needed.

0 引言Introduction

近年来，随着心脏外科手术、体外循环技术和重症监护整体水平的提高，心脏手术并发症的发生率和死亡率等均明显下降。脑损伤作为成人心脏外科术后一种严重的并发症，发病率依然较高，是除心功能不全以外导致心脏外科手术患者预后不良的最主要因素之一[1]。脑损伤发生率与手术类型有一定的关系，非心脏、非神经和非大血管的手术脑损伤发生率<1%；而大血管和心脏外科手术与前者相比，其发生率可达1%-3%[2]。心脏手术后卒中患者，1年后死亡率升至33%，5年后升至53%，大约50%的脑卒中幸存者伴有严重的后遗症[3-4]。为减少心脏外科手术后脑卒中并发症，迫切需要制定相关方面诊治规范。

目前中国成人心外科术后脑损伤诊治还没有统一的共识。为此，中国研究型医院学会神经再生与修复专业委员会心脏重症脑保护学组联合神经重症护理与康复学组，组织国内心脏内外科、神经内外科、重症监护、体外循环、麻醉以及急诊等医学专家，参考国内外相关指南，结合中国的实际情况，从成人心脏外科术后脑损伤的表现形式、危险因素、非药物性保护策略、术中神经监测以及药物性保护策略等方面，经多次讨论最终成稿，制定本专家共识，以期指导临床工作。

文章来源：《心脏杂志》 网址: http://www.xzzzzzs.cn/qikandaodu/2021/0205/336.html