左心室辅助装置植入术后神经系统并发症及相关因素分析  

Analysis of Neurological Complications and Related Risk Factors After Left Ventricular Assist Device Implantation

作　　者：张昊天 周星彤 尹泽琳 杜娟[1] 张奉庆 陈海波[1] 卿平[1] 王小虎 张泽 邹亮[1] 陈伊[1] 金琰 王现强[1] ZHANG Haotian;ZHOU Xingtong;YIN Zelin;DU Juan;ZHANG Fengqing;CHEN Haibo;QING Ping;WANG Xiaohu;ZHANG Ze;ZOU Liang;CHEN Yi;JIN Yan;WANG Xianqiang(Department of Cardiovascular Surgery,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心外科,北京100037

出　　处：《中国循环杂志》2025年第4期359-366,共8页Chinese Circulation Journal

基　　金：中央高水平医院临床科研业务费(零余额2023-GSP-GG-6,零余额2022-GSP-QZ-7);北京高等学校卓越青年科学家计划(2024-BZZQ01)。

摘　　要：目的:分析左心室辅助装置(LVAD)植入术后神经系统并发症的发生情况及相关因素。方法:回顾性纳入2017年6月至2024年9月在中国医学科学院阜外医院接受LVAD植入的151例患者,分析神经系统并发症发生情况,比较发生和未发生神经系统并发症患者的临床资料和术后生存情况,并分析LVAD植入术后发生神经系统并发症的相关因素。结果:LVAD植入术后21例(13.9%)患者发生神经系统并发症,其中15例缺血性脑卒中、5例出血性脑卒中(症状性颅内出血或蛛网膜下腔出血)、1例为短暂性脑缺血发作(TIA)。神经系统并发症总发生率为0.08/人年,缺血性脑卒中和出血性脑卒中发生率分别为0.06/人年和0.02/人年。与无神经系统并发症患者相比,神经系统并发症患者术前合并主动脉瓣反流及三尖瓣反流比例更高、术前甘油三酯水平更低,术中同期主动脉瓣置换术比例更高、术中同期左心耳切除比例更低(P均<0.05)。多因素Cox回归分析结果显示,术前高甘油三酯水平(HR=0.21,95%CI:0.08~0.56,P=0.002)为神经系统并发症的相关因素。中位随访时间为508.0(186.5,931.5)d,15例缺血性脑卒中患者中12例未遗留后遗症,3例遗留不同程度的后遗症;5例出血性脑卒中的患者均死亡,其中2例患者因颅内出血相关并发症死亡。Kaplan-Meier生存曲线分析显示,神经系统并发症患者的生存率低于无神经系统并发症患者(log-rank P=0.005)。结论:LVAD术后神经系统并发症以缺血性脑卒中为主,出血性脑卒中虽较少见,但预后更差。术前高甘油三酯水平为术后神经系统并发症的相关因素。Objectives:To evaluate the incidence of neurological complications following left ventricular assist device(LVAD)implantation and to investigate related risk factors.Methods:A retrospective analysis was conducted on 151 patients who underwent LVAD implantation at Fuwai Hospital between June 2017 and September 2024.Clinical characteristics and postoperative survival outcomes were compared between patients with and without neurological complications.Results:Neurological complications occurred in 21 patients(13.9%)postoperatively,15 cases were ischemic strokes,5 cases were symptomatic intracranial hemorrhages or subarachnoid hemorrhages,and 1 case was transient ischemic attack(TIA).The total incidence of neurological complications was 0.08 events per person-year(EPPY),ischemic stroke was 0.06 EPPY and hemorrhagic stroke was 0.02 EPPY.Compared with patients without neurological complications,patients with neurological complications had a higher proportion of preoperative aortic regurgitation and tricuspid regurgitation,lower triglyceride levels,a lower rate of concurrent left atrial appendage resection and a higher rate of concurrent aortic valve replacement surgery.Multivariate cox regression analysis revealed that higher preoperative triglyceride levels(HR=0.21,95%CI:0.08-0.56,P=0.002)were associated with neurological complications.The median follow-up time was 508.0(186.5,931.5)days,12 out of 15 cases of ischemic stroke experienced no long-term sequelae,while 3 patients had varying degrees of residual deficits.All 5 patients with hemorrhagic stroke died,with 2 deaths directly attributed to hemorrhage.Kaplan-Meier survival curve analysis indicated that patients with neurological complications had a significantly lower survival rate(log-rank P=0.005).Conclusions:Neurological complications after LVAD implantation are predominantly ischemic strokes.Although less frequent,hemorrhagic strokes are associated with worse outcomes.Higher preoperative triglyceride levels is associated with neurological complications.

关 键 词：左心室辅助装置 神经系统并发症 人工心脏 机械循环辅助 终末期心力衰竭 

分 类 号：R54[医药卫生—心血管疾病]