颈动脉狭窄及脑梗死对冠状动脉旁路移植术后患者脑卒中发生率和生存率的影响  

Effect of carotid arteriostenosis and cerebral infarction on postoperative cerebral complications and survival rate of patients with coronary artery bypass grafting

作　　者：刘帅[1] 高长青[1] 龚志云[1] 任崇雷[1] 肖苍松[1] 王嵘[1] 吴扬[1] 

机构地区：[1]解放军总医院心血管外科,北京100853

出　　处：《解放军医学院学报》2014年第7期651-653,673,共4页Academic Journal of Chinese PLA Medical School

基　　金：全军医学科技"十二五"重点项目(BWS11J030)~~

摘　　要：目的分析颈动脉狭窄及脑梗死对行冠状动脉旁路移植术（coronary artery bypass grafting，CABG）后患者脑卒中发生率和生存率的影响。方法2003年6月-2013年6月我科冠心病合并颈动脉狭窄患者159例，其中男性118例，女性41例，平均年龄为（67．0±7．5）岁，回顾性分析颈动脉狭窄及脑梗死对行CABG后患者脑卒中发生率和生存率的影响。结果随访146例，随访率93．6％，随访时间6～120（46．3±25．3）个月，10例术后出现神经系统症状，其中2例脑出血，8例脑梗死。17例死亡（4例因脑部并发症，1例因食管癌，1例因肺癌，11例为心源性），平均死亡时间为术后41（4～72）个月。不同颈动脉狭窄的患者术后近期和远期脑卒中发生率及生存率差异无统计学意义（P〉0．05）。术前合并脑梗死病史的患者术后脑卒中发生率及生存率与无脑梗死患者相比差异有统计学意义（P〈0．05）。结论颈动脉狭窄程度并不会影响CABG后近期及远期脑卒中的发生率和生存率，但远期脑卒中的发生率及生存率较无脑梗死病史患者明显增加。Objective To analyze the effect of carotid arteriostenosis and cerebral infarction on postoperative cerebral complications and survival rate after coronary artery bypass surgery grafting （CABG）. Methods The effect of carotid arteriostenosis and cerebral infarction on postoperative cerebral complications and survival rate after CABG in 159 patients （67.0± 7.5 years; 118 males and 41 females） admitted to our hosptial from June 2003 to June 2013 with carotid arteriostenosis and coronary heart diseases who accepted isolated CABG were retrospectively analyzed. Results Follow-up was done for 146 patients with a follow-up rate of 93.6% and the mean time of it was 6-120 （46.3 ±25.3） months. Ten patients had neurological symptoms, 2 patients got cerebral hemorrhage, 8 patients suffered from stroke. 17 patients had died during the follow-up （4 cerebral complication, 1 cancer of the esophagus, 1 lung cancer, 11 carcinogenic reason） with the mean time of 41（4-72） months after operation. The difference of postoperative cerebral complications and survival rate with different severity of carotid atherosclerosis had no statistical significance （P 〉 0.05）. Patients with preoperative cerebral infarction had higher postoperative stroke and mortality, which marked statistical significance （P 〈 0.05）. Conclusion Severity of carotid atherosclerosis can not increase the postoperative cerebral complications and survival rate, but patients with preoperative cerebral infarction are more likely to have stroke and higher mortality after operation than those patients with no cerebral infarction history.

关 键 词：冠状动脉旁路移植术 冠状动脉疾病 颈动脉狭窄 脑卒中 

分 类 号：R654.33[医药卫生—外科学]