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Kognitive Störungen nach kardiochirurgischen Eingriffen

Cognitive deterioration after cardiosurgery

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Zusammenfassung

In der Bundesrepublik werden jährlich rund 100.000 Patienten am Herzen operiert. Während schwere neurologische Komplikationen wie Hirninfarkte oder globale Ischämien glücklicherweise selten geworden sind, stellen kognitive Störungen weiterhin ein ungelöstes Problem dar. Die vorliegende Übersicht erörtert das klinische Bild und die bestehenden Erkenntnisse zur Pathophysiologie sowie Möglichkeiten zur Neuroprotektion. Eine postoperative kognitive Verschlechterung kann durch verschiedene Faktoren bedingt sein, von denen Mikroembolisation und zerebrovaskuläre Vorschäden eine wesentliche Rolle spielen. Die Nützlichkeit neuroprotektiver Methoden etwa zur Verringerung intrazerebraler Mikroembolien wurde inzwischen in klinischen Untersuchungen nachgewiesen.

Summary

Over 100,000 heart surgeries are performed in Germany annually. Although severe neurological complications like ischaemic strokes have meanwhile become rare occurrences, subtle neuropsychological changes are still frequently recognized after major heart surgeries. The hitherto unsolved problem of postoperative cognitive decline (POCD) is portrayed in this article. Multifactorial aetiologies including microembolism and preoperative risk factors are supposed to play a significant role in POCD. A variety of neuroprotective strategies such as intraoperative microemboli filtration have been suggested to minimize cerebral risks. The utility of neuroprotective methods has recently been verified in randomized studies.

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Abbreviations

ACB:

aortokoronarer Bypass

DBT:

dynamische Luftfalle

DWI:

diffusionsgewichtete Magnetresonanztomographie

HLM:

Herz-Lungen-Maschine

KHK:

koronare Herzkrankheit

MES:

mikroembolische Signale

MRT:

Magnetresonanztomographie

POCD:

postoperative kognitive Dysfunktion

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Authors and Affiliations

  1. Abteilung für Neurologie, Justus-Liebig-Universität Gießen, Gießen , Deutschland

    N. Schwarz, S. Kastaun, T. Gerriets & M. Kaps

  2. Abteilung für Herzchirurgie, Kerckhoff-Klinik, Bad Nauheim , Deutschland

    M. Schönburg

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Schwarz, N., Schönburg, M., Kastaun, S. et al. Kognitive Störungen nach kardiochirurgischen Eingriffen. Nervenarzt 82, 190–197 (2011). https://doi.org/10.1007/s00115-010-3116-3

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