体外循环术后并发脑梗死的危险因素分析  

Analysis of risk factors for cerebral infarction after cardiopulmonary bypass

作　　者：李传文[1] 孙庆燕[1] 李平萍[1] 李宪卿[1] 甘延清 费中化 LI Chuan-wen;SUN Qin-yan;LI Pin-pin(Affiliated Hospitai of Jining Medical College,ShandongJining 272029,China)

机构地区：[1]济宁医学院附属医院体外循环科,山东济宁272029 [2]济宁医学院附属医院心脏监护病房,山东济宁272029

出　　处：《中国实验诊断学》2022年第5期638-641,共4页Chinese Journal of Laboratory Diagnosis

基　　金：山东省医药卫生科技发展项目(2018WS01092);山东省高等学校科技计划项目(J17KA231)。

摘　　要：目的 分析体外循环(CPB)术后并发脑梗死的危险因素。方法 回顾性分析1670例择期行心脏手术患者的临床资料,根据典型的临床表现、CT、MRI,分为术后脑梗组(28例)和非脑梗组(对照组)(从1642例中随机选择28例)。对患者一般情况及术中情况进行单因素及多因素Logistic回归分析。结果术后确诊为脑梗死28例(1.67%),患者转机时间(P=0.024)、阻断时间(P=0.028)、转中最低平均动脉压(P=0.011)、最低温度(P=0.028)、血糖峰值(P=0.005)、乳酸峰值(P=0.014)、术后引流量(P=0.037)为术后发生脑梗死的危险因素,Logistic回归分析显示转机时间(P=0.048)及阻断时间(P=0.034)是CPB术后并发脑梗死的独立危险因素。结论 CPB术后脑梗死与多因素有关,转机时间及阻断时间是CPB术后并发脑梗死的独立危险因素。加强手术操作,选择合适的手术方式,缩短CPB和阻断时间,维持合适的灌注流量、压力,控制好温度,维持内环境的稳定是预防术后脑梗死的重要措施。Objective To Analysis risk factors for cerebral infarction after cardiopulmonary bypass(CPB).Methods The clinical data of 1670patients undergoing elective cardiac surgery were retrospectively analyzed.Based on typical clinical manifestations,CT and MRI,they were divided into postoperative cerebral infarction group(28cases)and noncerebral infarction group(control group)(28cases were randomly select from 1642cases).Univariate and multivariate Logistic regression analysis were performed on the general conditions of patients and intraoperative conditions.Results Twenty-eight patients(1.67%)were diagnosed with cerebral infarction after the operation.The patient’s transit time(P=0.024),block time(P=0.028),minimum mean arterial pressure(P=0.011),minimum temperature(P=0.028),peak blood glucose(P=0.005),peak lactate(P=0.014),postoperative drainage(P=0.037)were risk factors for cerebral infarction after surgery.Logistic regression analysis showed the transit time(P=0.048)and blockade time(P=0.034)independent risk factor for cerebral infarction after CPB.Conclusion Cerebral infarction after CPB was related to multiple factors,transit time and blocking time are independent risk factors for cerebral infarction after CPB.Strengthening the operation to shorten CPB and blocking time,maintaining proper perfusion flow and pressure,controlling temperature,and maintaining a stable internal environment were important measures to prevent postoperative cerebral infarction.

关 键 词：体外循环 脑梗死 危险因素 心脏手术 

分 类 号：R743[医药卫生—神经病学与精神病学]