非体外循环冠状动脉旁路移植术后再发脑卒中的临床分析

Stroke following off-pump coronary artery bypass grafting in patients with prior stroke

目的探讨非体外循环冠状动脉旁路移植（OPCABG）术后再发脑卒中的危险因素及临床特点。方法收集2006年1月至2009年7月437例OPCABG手术并且术前具有脑卒中史病人资料，采集病人手术前、后资料，根据术后有无再发脑卒中分成两组，进行单因素分析和多因素logistic回归分析。结果437例中术后再发脑卒中32例（7．3％），均为脑梗塞，无脑出血病例。单因素分析发现左室射血分数≤0．50、术后房颤与低血压在两组间差异有统计学意义（P〈0．01）。呼吸机辅助时间〉24h、ICU时间〉24h及住院时间在两组间差异有统计学意义（P〈0．05）。多因素logistic回归分析结果表明，左室射血分数≤0．50（OR=2．837，95％CI：1．238～6．498）、术后房颤（OR=3．065，95％CI：1．157～8．118）与术后低血压（OR=4．209，95％CI：1．805～9．813）是术后再发脑卒中的独立危险因素。结论左室射血分数≤0．50、术后房颤与低血压是OPCABG术后再发脑卒中的独立危险因素。OPCABG术后再发脑卒中者术后恢复较术后无脑卒中者差。

Objective To analyze the risk factors and clinical features of stroke following off-pump coronary artery bypass grafting in palients with prior stroke. Methods From Janumy 2006 to July 2009, the clinical information of 437 patients undergoing OPCABG in Anzhen Hospital was collected. The patients were divided into stroke group and non-stroke group according to whether stroke occurred after operation. Preoperative and operative variants were evaluated by univariate and muhivariate logistic stepwise regression analysis. Results 32 of 437 patients （7.3%） suffered fi＇om stroke after OPCABG, 32 cases were cerebral infarction and no case was cerebral hemorrhage. There were more patients whose left ventrieular ejection fraction ≤0.50 in stroke group than that in non-stroke group （ 12 of 32, 37.5% versus 69 of 405, 17.0%, P = 0. 004）, more patients had atrial fibrillation after operation in stroke group than that in non-stroke group （9 of 32, 28.1% versus 27 of 405, 6.7%, P 〈0. 001 ）, more patients had hypotension after operation in stroke group than that in non-stroke group （ 13 of 32, 40.6% versus 42 of 405, 10.4%＇, P 〈0.001 ）, more patients had ventilatol＇y time and ICU time after operation in stroke A- group than that in non-stroke group （9 of 32, 28.1% versus 49 of 405, 12.1%, P =0.021 ; 14of 32, 43.8% versus 97 of 405, 24.0%, P = 0.013 ）, and patients in stroke group took longer to stay in hospital than that in non-stroke group （29.0 ±15.8 versus 22.9 ± 10.4, P =0.002 ）. Logistie stepwise regression analysis showed that left ventricular ejection fraction ≤0.50（ OR = 2. 837, 95% CI ： 1. 238 - 6. 498 ）, atrial fibrillation after operation （ OR = 3. 065, 95% C1 ： 1. 157 - 8. 118 ） and hypotension after operation （ OR = 4. 209, 95% CI ： 1. 805 - 9.813 ） were independent risk factors of stroke following offpump coronary artery bypass grafting in patients with prior stroke. Conclusion This data suggest that left ventrieular ejection fraction ≤0.50, atrial fibrillation and hypotension after operation are risk factors for stroke following off-pump coronary artery bypass grafting in patients with prior stroke. These patients with stroke after operation took longer to extubate and stay in ICU and hospital.