中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (18): 3359-3362.doi: 10.3969/j.issn.1673-8225.2010.18.031

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

冠状动脉旁路移植后发生严重神经系统并发症的相关因素

言翊光，王东进，武  忠，李庆国，周  庆   

  1. 南京市鼓楼医院心胸外科， 江苏省南京市  210008
  • 出版日期:2010-04-30 发布日期:2010-04-30
  • 作者简介:言翊光★，男，1975年生，江苏省南京市人，汉族，2007年南京大学医学院毕业，硕士，医师，主要从事心胸外科研究。 yanyiguang@126.com

Relevant factors for severe neurologic complications after coronary artery bypass grafting

Yan Yi-guang, Wang Dong-jin, Wu Zhong, Li Qing-guo, Zhou Qing   

  1. Department of Cardio-thoracic Surgery, Nanjing Drumtower Hospital, Nanjing  210008, Jiangsu Province, China
  • Online:2010-04-30 Published:2010-04-30
  • About author:Yan Yi-guang★, Master, Physician, Department of Cardio-thoracic Surgery, Nanjing Drumtower Hospital, Nanjing 210008, Jiangsu Province, China yanyiguang@126.com

PDF

600

被引次数

15

摘要：

背景：冠脉搭桥后神经系统并发症发病率较高，其发病原因是多因素的。
目的：回顾性分析冠状动脉旁路移植后严重神经系统并发症的发生及其相关因素。
方法：选择2002-09/2009-08 南京市鼓楼医院冠脉搭桥患者761例，男443例，女318例，年龄32~89岁。按年龄(≥或<70岁)、体外循环冠脉搭桥或非体外循环下冠脉搭桥进行分组比较，使用统计学方法揭示神经系统并发症和其危险因素之间的关系。
结果与结论：76例冠脉搭桥患者中41例患者术后发生严重神经系统并发症，其中≥70岁组22例(14.9%)，< 70岁组19例(3.1%)，两组比较差异有非常显著性意义(P < 0.001)；体外循环冠脉搭桥组7例(5.3%), 非体外循环下冠脉搭桥 34例(5.4%),两组比较差异无显著性意义(P=0.39)，实验还发现颈动脉狭窄> 50%患者术后发生严重神经系统并发症概率较高；死亡8例，其中2例死于消化道大出血，1例死于严重感染，4例死于多脏器功能衰竭，1例死于术后癫痫持续发作。存活33例，平均随访3年，死亡3例，3例肢体活动障碍部分恢复，1例发生严重智力障碍。结果显示冠脉搭桥后神经系统并发症的发生受多因素影响，其中老龄(≥ 70岁)，颈动脉狭窄为最重要的危险因素之一，体外循环和非体外循环对术后并发症的影响未见明显差异。

关键词: 冠状动脉旁路移植, 神经系统并发症, 危险因素, 器官移植, 颈动脉狭窄

Abstract:

BACKGROUND: Neurological complications after coronary artery bypass grafting still have a high incidence rate, and the etiology is multiple.
OBJECTIVE: To retrospectively investigate the occurrence and relevant factors of severe neurological complications after coronary artery bypass grafting (CABG).
METHODS: A total of 761 consecutive patients with undergoing CABG were included in this study from September 2002 to August 2009 at the Nanjing Drumtower Hospital, including 443 males and 318 females, aged from 32-89 years. All patients were grouped according to age(more than or less than 70-year-old) and on pump or off pump coronary surgery. Disclose the relationship between the risk factors and the neurological complications by statistics analysis.
RESULTS AND CONCLUSION: Totally 41 patients had serious neurological complications in this study. There was a higher complication incidence in ≥70-year-old group patients (n =22) than < 70-year-old group (n =19)(14.9% vs. 3.1%, P < 0.001). The neurological complications incidence was similar in on-Pump CABG group (n =7) and off-Pump CABG group (n = 34) (5.3% vs. 5.4%, P=0.39). The incidence rate of severe neurological complications was high in carotid artery stenosis > 50% patients. A total of 8 cases died, 2 for massive hemorrhage of gastrointestinal tract; 1 for severe sepsis; 4 for multiple organ dysfunction syndrome; 1 for epilepsia gravior postoperatively. Finally, 33 cases survived. The average time of follow up was 3 years, 3 cases died, 3 cases recovery from limitation of limb or hand movement partly, and 1 case had severe mental retardation. Results displayed that elderly patients(≥ 70 years) undergoing CABG are at higher risk of neurological dysfunction. Carotid artery stenosis is the most risk factor. There are no significant effects on postoperative complications between on-pump CABG and off-pump CABG.

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