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Neuropsychological Sequelae of Pulmonary Thromboendarterectomy

其他書名	A Prospective, Controlled Study
出版	University of California, San Diego and San Diego State University, 1995
URL	http://books.google.com.hk/books?id=ovH8-uH6F0sC&hl=&source=gbs_api

註釋Pulmonary thromboendarterectomy (PTE), a surgical procedure requiring prolonged cardiopulmonary bypass, hypothermia, and periods of circulatory arrest, is utilized to treat patients with chronic, thromboembolic pulmonary hypertension. While previous research has observed marked improvements in the physical functioning of patients following PTE, no study to date has examined changes in neuropsychological functioning following PTE. Such PTE-neuropsychological research is important because studies examining the cognitive functioning of patients following cardiac surgery have demonstrated generalized, but transient, post-surgical neuropsychological impairments. The present study prospectively examined potential changes in the pre- versus two-week post-surgical neuropsychological functioning of 38 patients undergoing PTE. Attention/concentration, simple and complex motor skills, verbal fluency, verbal learning/memory, and affect were assessed. A non-surgical comparison group of 13 patients with two types of lung disease (LD), who had physical functioning characteristics (e.g., hypoxia) similar to those of pre-surgical PTE patients, was utilized to control for neuropsychological test-retest effects. Regression analyses using the LD group allowed for creation of normed test-retest LD T scores for change which were compared to PTE T scores for change by unpaired t-tests. A Normal Control (NC) group (n = 24) demographically-matched to the PTE group was utilized to assess the effect of chronic hypoxia on pre-surgical cognitive functioning. Baseline ANOVA comparison (with Tukey post-hoc comparisons) of these 3 groups (PTE, LD, and NC) revealed similarly impaired cognitive functioning in the PTE and LD groups as compared to the NC group on measures of sustained attention, and verbal learning and memory. At baseline, PTE and LD subjects also endorsed greater levels of depression as compared to NC subjects. Longitudinal comparisons of PTE versus LD subjects two weeks after PTE surgery revealed significant declines in PTE patients on measures of complex motor skills, verbal fluency, and verbal learning/memory, and significant improvements on measures of simple motor speed and depression. Trends towards negative change after PTE were seen in attention/concentration. Preliminary findings with a small subgroup (n = 10) of PTE patients one year after surgery suggests that the above-mentioned two-week post-surgical negative changes may be transient. However, no conclusions can be drawn from these findings because the one-year follow up sample is small and possibly non-representative, and no comparison group was available to control for test-retest effects. Further research is needed to clarify the duration and course of post-PTE neurobehavioral changes.