冠状动脉旁路移植术后神经系统合并症的研究  

A study of neurological complications after coronary artery bypass grafting

作　　者：毕齐[1] 李琴[1] 张兆琪[2] 顾承雄[3] 马晓海[2] 

机构地区：[1]首都医科大学附属北京安贞医院神经内科,100029 [2]首都医科大学附属北京安贞医院医学影像科,100029 [3]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华内科杂志》2008年第3期202-205,共4页Chinese Journal of Internal Medicine

基　　金：2003年首都医学发展科研基金（2003-3056）

摘　　要：目的前瞻性研究非体外循环下冠状动脉旁路移植术（OPCABG）后神经系统合并症术后的种类、发生率、危险因素和防治方法。方法对55例OPCABG患者进行美国国立卫生研究院卒中量表评分，行认知功能、焦虑／抑郁测评及颅脑影像学检查，术后确认有无神经系统合并症以及种类分成两组，组间进行单因素分析。结果术后缺血性脑血管病2例（2／55），无死亡病例。与术后无神经系统合并症组比较，危险因素单因素分析无统计学意义（P〉0．05）；手术前后无认知功能异常，简易智能状态量表、临床痴呆量表、总体衰退量表评分手术前后差异无统计学意义（P〉0．05）；除2例神经系统合并症外，余手术前后影像学检查无明显改变（P〉0．05）；术前轻度焦虑7例，轻度抑郁1例，整体焦虑自评量表和抑郁自评量表手术前后评分无明显改变（P〉0．05）。结论OPCABG后认知功能、影像学、焦虑及抑郁在手术前后无明显改变；OPCABG对神经系统而言相对安全。Objective To prospectively investigate the neurological complications （NC） after offpump coronary artery bypass grafting （OPCABG）, including the kinds of NC and their mobility, risk factors, prevetion and treatment. Methods A total of 55 consecutive patients with undergoing OPCABG were evaluated from March to June 2006 at the Department of Cardiosurgery in Beijing Anzhen Hospital. Risk factors of NC were collected before operation. Nervous system physical examination, The NIH Stroke Scale（NIHSS） score evaluation, cognitive tests, imaging examination（ MRI, MRA and f-MRI ） ,anxious and depression scale were performed before and after OPCABG. NC and their kinds were identified after surgery. According to the presence or absence of NC after the operation, the patients were divided into two groups, and univariate analysis was used between the two groups. P 〈 0. 05 was considered of statisticaUy significant difference. Results （1） 2 cases of ischemic stroke developed after surgery（2/55）, but there no case of mortality. The risk factors were not statistically different between the two groups（P 〉0. 05） ;（2） For all the patients, cognitive evaluation was normal and unchanged before and after surgery （ P 〉 0. 05 ）, including Mini-Mental State Examination （ MMSE）, Clinical dementia rating （CDR） and Global Deterioration Scale （ GDS ） ; （3） Except the 2 cases of stroke, the others were normal and had no change on MRI, MRA, and f-MRI（ P 〉 0. 05）before and after surgery; （4） 7 patients with slight anxiety and one with sight depression before operation recovered completely after surerty without treatment. Both the Self-rating Anxiety Scale （SAS） and Self-rating Depression Scale （SDS）were normal and unchanged before and after surgery（ P 〉 0. 05）. Conclusions 2 cases of ischemic stroke were found among 55 patients undergoing OPCABG （2/55） and there was no mortality. There was no obvious change of cognitive function, imaging finding, anxiety and d

关 键 词：冠状动脉血管重建术 神经系统合并症 术后 认知功能 

分 类 号：R686[医药卫生—骨科学]