非体外循环冠状动脉旁路移植术后血制品的应用以及脑梗死危险因素分析

Use of blood products and risk factors of cerebral infarction after off-pump coronary artery bypass surgery

目的:探索非体外循环冠状动脉旁路移植术(OPCABG)术后血制品的应用与脑梗死的关系。方法:收集北京安贞医院住院的301例OPCABG患者术前、术中和术后资料包括输血类型和数量以及脑梗死的发生时间。根据术后是否出现脑梗死,将所有患者分为脑梗死组(n=25)和对照组(n=276)。应用Logistic回归分析OPCABG术后脑梗死的危险因素。结果:脑梗死组左心室射血分数≤50%的患者明显多于对照组;脑梗死组呼吸机辅助时间>48h、住院时间、ICU时间、术后低血压的发生率明显高于对照组;脑梗死组输血浆量和输血小板量明显高于对照组,且脑梗死组输血小板的人数明显高于对照组(P<0.05)。多因素回归分析结果显示,术后低血压、输血浆以及输血小板是术后脑梗死的危险因素。结论:围术期输血小板或血浆是CABG术后脑梗死的危险因素之一,对于术后出血量多的患者应重点关注患者神经功能的变化并进行对症处理。输血小板和血浆的不良影响机制需要进一步研究。

Objective： This study was designed to examine the effect of blood products on the occurrence of cerebral infarction after off-pump coronary artery bypass surgery(OPCABG）. Methods： Three hundred and one patients who underwent OPCABG in Beijing Anzhen Hospital were divided into cerebral infarction group(n = 25） and control group(n = 276）,Complete pre-,intra-and postoperative data including the occurrence time of cerebral infarction as well as the type and number of transfused blood products were available in all patients. Risk factors for new cerebral infarction after OPCABG by logistic regression analysis were analyzed. Results： The incidence of left ventricular ejection fraction of less than or equal to 50% in cerebral infarction group were significantly higher than that in the control group; The incidence of mechanical ventilation time 48 h,hospitalization time,ICU time,postoperative hypotension in cerebral infarction group was significantly higher than that of control group. The number of plasma transfusion and platelet transfusion were significantly higher than control group,and the number of patients who transfused platelet in the cerebral infarction group was significantly higher than the control group(P〈0. 05）. Multivariate logistic regression analysis showed that postoperative hypotension,plasma transfusion and platelet transfusion were independent risk factors for postoperative new onset cerebral infarction. Conclusion： The result of this study indicated that transfusion of platelets and/or plasma were independent predictors of stroke after OPCABG. For patients with excessive bleeding,we should pay attention to the changes of neurological function and symptomatic treatments. The mechanisms behind the deleterious impact of platelet and plasma transfusion are less known and require further investigations.