Açık kalp cerrahisinde serebral koruma

Cerrahi, kardiyopulmoner bypass (KPB) ve anestezi yöntemlerindeki gelişmelere rağmen kalp cerrahisine bağlı gelişen nörokognitif bozukluklar postoperatif morbiditenin hala en önemli nedenlerden biridir. Kalp cerrahisi sonrasında inme gibi ciddi nörolojik hasar gelişme sıklığı düşük olmakla birlikte nörokognitif değişiklik gelişme riski oldukça fazladır. Nörokognitif bozuklukların etiyolojisinde mikro ve makro emboliler, serebral hipoperfüzyon, inflamasyon ve pulsatil olmayan akım gibi birçok faktör rol alabilmektedir. Bu derlemede; nörokognitif bozuklukların olası mekanizmaları, nörolojik hasarın sıklık ve ciddiyetini artıran faktörler ile etkili bazı serebral koruyucu farmakolojik ajanlar gözden geçirilmiştir. Bunun dışında kalp cerrahisi sırasında serebral kan akımını etkileyen faktörlerden de bahsedilmiştir.

Anahtar Kelimeler:

Kalp damar cerrahi işlemleri, Kardiyopulmoner bypass, Kan dolaşımı

Cerebral protection in open heart surgery

Despite remarkable progress in surgical, cardiopulmonary bypass (CPB) and anesthetic techniques, neurocognitive damage still remains an important cause of postoperative morbidity in cardiac surgery. Although the incidence of overt neurological injury (such as stroke) is low, more subtle neurocognitive changes frequently occur. The aetiology of neurocognitive damage is likely to be multifocal: including macro- and micro-emboli, cerebral hypoperfusion, inflammation and nonpulsatile flow. In this review, some possible mechanisms of neurocognitive damage, factors that have been associated with an increased incidence and severity of neurologic injury, and some effective neuroprotective strategies are reviewed. Factors affecting cerebral blood flow during cardiac surgery are also described.

Keywords:

Cardiovascular Surgical Procedures, Cardiopulmonary Bypass, Blood Circulation,

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