应用超声波评价冠状动脉旁路移植术患者脑缺血并发症的危险因素  

Evaluation of the risk factor by using ultrasound in the patients with cerebral ischemic complication for coronary artery bypass grafting

作　　者：李京宏[1] 华扬[2] 王凤林[3] 董宗俊[1] 尚学斌[1] 刘燕辉[1] 

机构地区：[1]首都医科大学宣武医院心脏外科,北京100053 [2]首都医科大学宣武医院超声波室 [3]中日友好医院心血管外科,北京100029

出　　处：《中国胸心血管外科临床杂志》2003年第1期18-21,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的　为减少冠状动脉旁路移植术 (CABG)患者术后脑缺血并发症的发生 ,评价其危险因素。　方法　术前对连续施行 CABG的 6 5例患者常规行双功能彩色多普勒血流图象 (CDFI)和经颅多普勒 (TCD)检查 ,观察颈动脉和颅内动脉形态学和血流动力学指标的改变 (包括颈动脉内膜厚度、斑块的发生、血管狭窄率等 )。　结果　 CDFI检测异常 5 7例 (87.7% ) ;颈内动脉狭窄 >5 0 % 13例 ,其中单侧狭窄 5 0 %～ 6 9% 6例 ,双侧狭窄 5 0 %～ 6 9% 2例 ,双侧狭窄 70 %～ 99% 1例 ,一侧颈内动脉闭塞、一侧狭窄 >5 0 % 4例。 TCD发现颅内动脉单支狭窄 8例 ,多支狭窄 2 5例。术后死亡 2例 (3.1% ) ,围术期心肌梗死 2例。冠状动脉 3支病变患者颈动脉内膜增厚和多发性斑块发生率明显高于 2支病变患者 (χ2 =4 .37,8.5 6 ;P=0 .0 34,0 .0 13)。　结论　术前行 CDFI和 TCD检查对颈动脉和颅内动脉硬化病变是一种可行的无创筛选方法 ,对减少 CABG患者脑缺血并发症 ,提高冠心病的外科治疗水平很有价值。Objective To reduce the cerebral ischemic complications of coronary artery bypass grafting (CABG), the risk factors was evaluated. Methods Sixty five sequent patients of CABG were detected by means of color Doppler flow imaging(CDFI) and transcranial Doppler (TCD) before operation regularly. The morphology and hemodynamic changes of carotid artery and intracranial vessels,including the intima media thickness, atherosclerosis plaque of carotid artery and the stenotic rate of the arteries were investigated. Results The abnormal CDFI finding occurred in 57 cases. Thirteen patients had carotid stenosis >50%, in which 6 cases showed 50%-69% carotid stenosis in one side and 2 in two side, 1 case showed 70%-99% carotid stenosis in two side , and 4 cases showed one side occlusion and the other side stenosis >50% .Intracranial artery atherosclerosis was detected by TCD,in which single vessel stenosis happened in 8 cases, multi vessel stenosis were 25 cases.Two patients(3 1%) died early after surgery, 2 cases developed postoperative myocardiac infarction .It is showed that the difference between the occurred ratio of intima media thickness and atherosclerosis plaque of carotid artery with three vessel coronary artery diseases was higher than those in two vessel (χ 2=4.37, 8.56; P =0 034, 0.013). Conclusions Detecting the atherosclerosis of carotid artery and intracranial arteries of the patients before CABG by CDFI and TCD is a very useful method. It is valued in decreasing the incidence of cerebral ischemic complications during CABG and increasing the efficiency of the coronary artery surgery.

关 键 词：超声波 评价 冠状动脉旁路移植术 脑缺血 并发症 危险因素 

分 类 号：R654.2[医药卫生—外科学] R743.31[医药卫生—临床医学]