Effects of balloon-induced pulsatile perfusion on postoperative short- and long-term cognitive dysfunction in diabetic patients with impaired cerebrovascular carbon dioxide reactivity

摘要

Objectives: The purpose of this study was to identify whether reduced jugular venous oxygen saturation (SjvO2) in diabetic patients with impaired cerebrovascular carbon dioxide (CO2) reactivity could be improved by pulsatile perfusion during cardiopulmonary bypass (CPB) and whether improved SjvO2 could improve postoperative cognitive dysfunction after coronary artery bypass graft surgery. Setting: A prospective, observational study. Participants: Ninety-nine diabetic patients with impaired CO2 reactivity ( 3%/mmHg). Interventions: Ninety-nine diabetic patients divided into 2 groups: group 1 received an intra-aortic balloon pump (IABP) after the induction of anesthesia and group 2 did not. Group 1 received pulsatile perfusion during CPB, and group 2 received nonpulsatile perfusion during CPB. Measurements and Main Results: Hemodynamic data (arterial and jugular venous gas values) were measured during CPB. All patients underwent neurologic and neuropsychologic tests the day before surgery and 7 days and 6 months after surgery. The duration of SjvO2 ≤50% during CPB was shorter in group 1 (13 ± 5 minutes) than in group 2 (20 ± 6 minutes, p 0.01). No significant differences in the rate of cognitive dysfunction were observed between groups at 7 days and 6 months postoperatively. Conclusions: Pulsatile perfusion flow generated by the IABP could reduce the decrease in SjvO2 values during CPB, but amelioration of SjvO 2 values was not associated with short- or long-term postoperative cognitive dysfunction in diabetic patients with impaired CO2 reactivity.