颈动脉粥样硬化与冠状动脉旁路移植术后神经系统并发症相关性研究  

The relationship of carotid atherosclerosis and neurological outcomes in patients undergoing off-pump coronary artery bypass grafting

作　　者：宋哲[1] 毕齐[1] 李俊玉[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所神经内科,北京100029

出　　处：《心肺血管病杂志》2013年第4期459-462,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都医学发展科研基金(2009-2075);北京市科技计划(Z111107058811013)

摘　　要：目的:探讨颈动脉粥样硬化程度与非体外循环下冠状动脉旁路移植术后,神经系统并发症的关系。方法:连续选择择期行非体外循环下冠状动脉旁路移植术的患者475例,根据颈动脉超声结果分为四组:无狭窄、轻度、中度及重度狭窄,分析狭窄程度与术后神经系统并发症的关系及影响因素。结果:①四组患者之间年龄、脑卒中病史、糖尿病史及神经系统并发症比较,差异有统计学意义(P<0.05);②颈动脉狭窄患者术后神经系统并发症的发生率高于无颈动脉狭窄患者(χ2=3.851,P=0.050);③脑卒中病史(OR=1.835,95%CI:1.023～3.289,P<0.05)、颈动脉重度狭窄(OR=2.793,95%CI:1.296～6.018,P<0.05)与术后神经系统并发症相关(P<0.05)。结论:脑卒中病史、颈动脉重度狭窄是旁路移植术后神经系统并发症的危险因素。颈动脉不论狭窄程度,均可导致术后神经系统并发症发生率增高,低灌注可能为主要原因。Objective：To investigate the relationship of carotid atherosclerosis and the incidence of neurological complication in patients undergoing off-pump coronary artery bypass grafting.Methods：475 consecutive patients undergoing selective off-pump coronary artery bypass grafting was divided into four groups according the results of Carotid ultrasound： no stenosis,mild,moderate and severe stenosis,Analysis the relationship of carotid artery stenosis and neurological outcomes in patients undergoing off-pump coronary artery bypass grafting.Results： ① Age,stroke history,diabetes history and neurological outcomes takes statistic difference among four groups（P0.05）.② The incidence of postoperative neurological complications in patients with carotid artery stenosis is higher than patients without carotid artery stenosis（P=0.050）.③ In multivariate analysis,stroke history（OR=1.835,95%CI： 1.023~3.289,P0.05）and carotid artery severe stenosis（OR=2.793,95%CI： 1.296~6.018,P0.05）is related to postoperative neurological complications.（P0.05）Conclusion：Stroke history and carotid artery severe stenosis is the risk factor of neurological complications after off-pump coronary artery bypass grafting.Carotid artery stenosis cause higer incidence of neurological complications no matter the degree of stenosis.Hypoperfusion may be the main reason cause neurological complications after off-pump coronary artery bypass grafting.

关 键 词：冠状动脉旁路移植术 非体外循环 颈动脉狭窄 神经系统并发症 

分 类 号：R54[医药卫生—心血管疾病]