中国全科医学2016，Vol.19Issue(1)：68-72,5.DOI:10.3969/j.issn.1007-9572.2016.01.013
术前脑血管评估对非体外循环冠状动脉旁路移植术后神经系统并发症的影响研究
Influence of Preoperative Cerebrovascular Evaluation on Neurological Complications Following Off -Pump Coronary Artery Bypass Grafting
摘要
Abstract
Objective To investigate the incidence and risk factors of neurological complications ( NC) following off-pump coronary artery bypass grafting (OPCABG) .Methods We recruited 556 patients who were admitted into Department of Cardiac Surgery of Beijing Anzhen University and underwent OPCABG there from July 2010 to July 2012.Before surgery , the subjects all received 320-row dynamic volume CT to evaluate cerebral perfusion , and cerebral CTA was used to evaluate the condition of cerebrovascular stenosis .All patients received NC evaluation before surgery and one week after surgery .According to whether NC occurs after OPCABG , the subjects were divided into two groups: NC group ( n=118 ) and non -NC group ( n=438) .The influence of abnormality of cerebral perfusion and the condition of stenosis evaluated by CTA on postoperative NC was analyzed.Results The total incidence of NC was 21.2% (118/556), and among the NC events, cerebral infarction, hypoxic-ischemic encephalopathy , delirium, postoperative cognitive dysfunction and anxiety and depression accounted for 1.3% (7/556), 2.9% (16/556), 1.1% (6/556), 11.9% (66/556) and 6.0% (33/556) .The NC group was higher than non -NC group in the proportion of patients with history of cerebrovascular disease , proportion of cerebral perfusion abnormity and the degree of coronary artery stenosis evaluated by CTA ( P <0.05 ) .Multivariate logistic regression analysis showed that history of cerebrovascular disease and preoperative abnormality of cerebral perfusion were independent influencing factors for the occurrence of NC after surgery ( P<0.05) .Multivariate logistic regression showed that , compared with patients with no stenosis detected by CTA , the OR (95%CI) of NC in patients with serious stenosis after surgery was 2.25 (1.35, 3.77), P<0.05.Difference values among temporal lobe , occipital lobe and basal ganglia region in time to peak (TTP) and the difference value between occipital lobe and basal ganglia region in mean transit time ( MTT) of contrast agent were significantly higher in the NC group than those in non -NC group ( P<0.05 ) .Conclusion The incidence of NC is high after OPCABG , and the history of cerebrovascular disease and the preoperative cerebral perfusion abnormality are independent risk factors for postoperative NC.With the increase of stenosis detected by cerebral CTA , the incident of postoperative NC increases关键词
冠状动脉旁路移植术,非体外循环/神经系统/手术后并发症/影响因素分析Key words
Coronary artery bypass/off-pump/Nervous system/Postoperative complications/Root cause analysis分类
医药卫生引用本文复制引用
许保磊,毕齐,陈明盈,骆迪,乔秋博..术前脑血管评估对非体外循环冠状动脉旁路移植术后神经系统并发症的影响研究[J].中国全科医学,2016,19(1):68-72,5.基金项目
首都医学发展科研基金资助项目(2009-2075) （2009-2075）
