تأثير تزريق متيل پردنيزولون وريدي پيرامون عمل بر بروز عوارض شناختي بيماران به دنبال باي پس قلبي ريوي در جراحي عروق كرونري

Effect of methyl prednisolone on postoperative cognitive dysfunction following on pump Coronary Artery Bypass Grafting

Background: Despite of improved outcomes after cardiac surgery with cardiopulmonary bypass (CPB), postoperative cognitive complication remains a common problem (30 to 79% of cases) that is related to increased morbidity and prolonged hospital stay. The effects of corticosteroids on CPB-associated brain damage have not been documented. The purpose of this study was to evaluate the effects of methyl prednisolone (MP) on postoperative cognitive dysfunction in cardiac surgery with CPB. Materials and Methods: In a randomized double-blinded clinical trial study, 60 consecutive adult patients undergoing coronary artery bypass under CPB were enrolled in the study. They were randomly assigned to three groups: group A (n = 20) received 15 mg/kg MP by an intravenous infusion after induction of anesthesia and group B (n = 20) received 15 mg/kg intravenously, before the onset of CPB. Group C (n = 20) received placebo and was considered as control group. Mini Mental State Examination (MMSE) was used to screen patients for postoperative cognitive status (maximum score= 27). The MMSE was performed the day before surgery and one and two days later. SPSS software and appropriate tests including Q and ANOVA and Duncan tests were used to analyze the data. A p-value of less than 0.05 was considered as significant. Results: Among intraoperative variables, there were no significant differences among the three groups concerning the CPB duration and operation duration. MMSE scores were similar preoperatively in the three groups (24.3+2.4, 24.2+2.4, 24.3+2.8 respectively). The scores were significantly more (better) in the group A (24.6+2.3, 25.2+1.7) than the group B (21.6+3.1, 22.6+2.4) and the group C (21.5+3.1, 21.9+2.6) at the first and second postoperative days respectively. The length of postoperative ICU stay of the Group B and C patients was greater. Conclusion: Methyl prednisolone is able to reliably and clinically improve postoperative cognitive dysfunction following cardiac surgery with cardiopulmonary bypass if used at the beginning of the surgery.