术前颈动脉评估与非体外循环冠状动脉旁路移植术后神经系统并发症的相关性  

Association between carotid artery assessment before operation and neurological complications after OPCAB

作　　者：许保磊[1] 毕齐[1] 宋哲[1] 李俊玉[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]中国康复研究中心北京博爱医院急诊科

出　　处：《中华老年心脑血管病杂志》2015年第11期1133-1136,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨非体外循环下冠状动脉旁路移植术（OPCAB）后神经系统并发症（NC）的发病率及其危险因素,并观察颈动脉狭窄与术后NC的关系。方法收集2010年7月~2012年7月住北京安贞医院行OPCAB患者556例,术前完善患者一般情况及既往史,采集头部CT平扫及颈动脉超声结果;术前及术后7d评估患者神经系统功能,判断术后是否发生NC,分为NC组118例与非NC组438例;分析术后NC的危险因素,并探讨颈动脉狭窄与术后NC的相关性。结果术后NC总发病率为21.2%,其中脑梗死0.7%,缺血缺氧性脑病2.9%,谵妄为0.7%,术后认知功能障碍10.6%,焦虑、抑郁状态4.9%。与非NC组比较,NC组脑卒中、颈动脉狭窄显著升高（P〈0.05）。多因素logisitic回归分析显示,随着颈动脉狭窄程度增加,术后发生NC的风险逐渐增加。与颈动脉无狭窄的患者比较,重度狭窄患者术后发生NC的OR值为2.23（95%CI：1.08~4.61,P=0.030）。结论OPCAB术后NC发病率较高,随着颈动脉狭窄程度增加,术后发生NC的风险逐渐增加。Objective To study the association between carotid artery assessment before operation and neurological complications（NC）after off-pump coronary artery bypass（OPCAB）.MethodsFive hundred and fifty-six patients who underwent OPCAB from July 2010 to July 2012 in our hospital were included in this study.Their general condition,past medical history,head CT scanning and carotid ultrasonography data were recorded before operation.Their nerve function was assessed before and 7days after operation in order to judge whether NC ocurred.The patients were divided into NC group（n=118）and control group（n=438）.The association between carotid artery stenosis and risk factors for postoperative NC was analyzed.Results The total incidence of NC was 21.2%.The incidence of ischemic stroke,anoxic encephalopathy,delirium,postoperative cognition impairment,and anxiety/depression was 0.7%,2.9%,0.7%,10.6% and 4.9% respectively.The incidence of ischemic stroke and carotid artery stenosis was significantly higher in NC group than in control group（P〈0.05）.Multivariate logistic regression analysis showed that the incidence of postoperative NC increased with the severity of carotid artery stenosis（OR=2.23,95%CI：1.08-4.61,P=0.030）.Conclusion The incidence of NC following OPCAB increases with the severity of carotid artery stenosis.

关 键 词：冠状动脉旁路移植术 非体外循环 手术后并发症 发病率 颈动脉狭窄 

分 类 号：R654.2[医药卫生—外科学]