同期颈动脉内膜切除术联合冠状动脉旁路移植术后脑灌注改变的相关分析  

Correlation factors analysis of changes in cerebral blood flow after simultaneous carotid endarterectomy and coronary artery bypass grafting

作　　者：韩芸峰[1] 侯超凡 王涛[1] 徐慧敏[2] 袁慧书[2] 杨军 赵鸿[3] 凌云鹏[3] Han Yunfeng;Hou Chaofan;Wang Tao;Xu Huimin;Yuan Huishu;Yang Jun;Zhao Hong;Ling Yunpeng(Department of Neurosurgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院神经外科,100191 [2]北京大学第三医院放射科,100191 [3]北京大学第三医院心外科,100191

出　　处：《中国脑血管病杂志》2022年第3期148-153,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(82071308);北京市自然科学基金资助项目(7192219);北京大学第三医院临床重点项目(BYSYZD2019040、BYSY2015013)。

摘　　要：目的探讨颈动脉狭窄合并冠状动脉狭窄患者行同期颈动脉内膜切除术(CEA)联合冠状动脉旁路移植术(CABG)后脑灌注的变化情况,分析脑灌注变化的相关因素。方法回顾性分析2014年9月至2021年3月在北京大学第三医院神经外科连续收治的35例颈动脉狭窄合并冠状动脉狭窄患者的临床资料,包括性别、年龄、既往史(吸烟、高血压病、糖尿病等)、术前实验室检查结果(血清N末端B型钠尿肽前体、三酰甘油、总胆固醇和高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸、空腹血糖等)、影像学资料[包括CT血管成像(CTA)及头部CT灌注(CTP)成像、颈动脉超声、超声心动图及冠状动脉造影等检查]及治疗情况。所有患者同期行CEA+CABG。术前和术后行头颈动脉CTA及头部CTP成像检查,以脑血流量(CBF)代表脑灌注情况,计算手术前后术侧和对侧相对脑血流量(rCBF)及CBF变化率(DR CBF),通过Pearson相关性分析探讨脑灌注变化的相关因素。结果头部CTP成像示,术前术侧CBF为(19.4±2.2)ml/(100 g·min),对侧CBF为(24.4±4.7)ml/(100 g·min),rCBF为0.52~1.00,平均0.82±0.17;术后术侧CBF为(24.6±2.8)ml/(100 g·min),对侧CBF为(28.1±5.7)ml/(100 g·min),rCBF为0.68~1.35,平均0.90±0.16;与术前比较,术后rCBF明显升高,差异有统计学意义(t=-8.194,P<0.01);DR_(CBF)为4%~62%,平均(28±14)%。DR_(CBF)与颈动脉狭窄率呈高度正相关(r=0.826,P<0.01),与颈动脉收缩期最大峰值流速(r=0.701,P<0.01)、左心室射血分数(r=0.602,P<0.01)、同型半胱氨酸水平(r=0.473,P<0.01)呈正相关,与术前rCBF呈负相关(r=-0.421,P<0.01)。结论颈动脉狭窄程度及心功能与颈动脉狭窄合并冠状动脉狭窄手术前后脑灌注改变相关,有待于大样本多因素分析进一步验证。Objective To investigate the changes of cerebral perfusion after simultaneous carotid endarterectomy(CEA)and coronary artery bypass graft(CABG)in patients with carotid stenosis and coronary stenosis,and to analyze the correlation factors with cerebral perfusion change.Methods The clinical data of 35 patients with carotid stenosis and coronary stenosis treated in the Neurosurgery Department of Peking University Third Hospital from September 2014 to March 2021 were analyzed retrospectively,including gender,age,past medical history(smoking,hypertension,diabetes,etc.),preoperative laboratory results(NT-proBNP,three acyl glycerin,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,homocysteine,fasting glucose,etc.),imaging data(including CT angiography[CTA]and cerebral CT perfusion[CTP]imaging,carotid ultrasound,echocardiography,coronary angiography,etc.)and treatment.All patients underwent CEA+CABG at the same time.CTA and CTP were performed before and after operation.Cerebral blood flow(CBF)was used to represent cerebral perfusion.The relative cerebral blood flow(rCBF)and the rate of change of CBF(DR_(CBF))were calculated before and after operation,and the correlation factors of cerebral perfusion were analyzed by Pearson correlation analysis.Results Brain CTP imaging showed that preoperative CBF was(19.4±2.2)ml/(100 g·min)on the operative side and(24.4±4.7)ml/(100 g·min)on the contralateral side,with rCBF ranging from 0.52 to 1.00,with an average of 0.82±0.17.Postoperative CBF was(24.6±2.8)ml/(100 g·min)and contralateral CBF was(28.1±5.7)ml/(100 g·min).rCBF ranged from 0.68 to 1.35,with an average of 0.90±0.16.The rCBF postoperation was significantly higher than that before surgery,and the difference was statistically significant(t=-8.194,P<0.01).DR_(CBF) ranged from 4%to 62%,with an average of(28±14)%.DR_(CBF) was highly positively correlated with the rate of carotid stenosis(r=0.826,P<0.01)and positively with the maximum peak systolic velocity in carotid artery(r=

关 键 词：颈动脉狭窄 冠状动脉狭窄 颈动脉内膜切除术 冠状动脉旁路移植术 脑灌注 

分 类 号：R651.1[医药卫生—外科学]