颈动脉狭窄患者行非体外循环冠状动脉旁路移植术后中枢神经系统并发症的回顾性队列研究

Central nervous system complications in patients with carotid artery stenosis undergoing off-pump coronary artery bypass grafting:A retrospective cohort study

目的分析颈动脉狭窄程度及颈动脉干预处理对非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)后中枢神经系统并发症发生率的影响及相关危险因素。方法选取青岛大学附属医院2018年6月—2021年6月完成的1150例OPCABG手术患者,按有无中枢神经系统并发症将患者分为两组,有神经系统并发症组[n=61,男43例、女18例,年龄68.0(63.0,74.0)岁],无神经系统并发症组[n=1089,男796例、女293例,年龄65.5(59.0,70.0)岁]。分析确定OPCABG术后中枢神经系统并发症发生的危险因素。结果单因素分析显示,年龄、吸烟、高脂血症、术前左室射血分数、术中使用主动脉内球囊反搏(intraaortic ballon pump,IABP)、术后心律失常、术后二次开胸、输血量与中枢神经系统并发症发生率有相关性(P<0.05)。颈动脉重度狭窄或闭塞患者中枢神经系统并发症发生率(11.63%)显著高于无狭窄及轻度狭窄组(4.80%)、中度狭窄组(4.76%)患者,差异有统计学意义(P=0.038)。颈动脉干预组中枢神经系统并发症发生率(42.11%)高于颈动脉未干预组(2.99%),差异有统计学意义(P<0.001)。年龄、术后心律失常、单侧或双侧颈动脉重度狭窄及闭塞是术后中枢神经系统并发症的独立危险因素(P<0.05)。结论年龄、吸烟、高脂血症、术前左室射血分数、术中使用IABP、术后心律失常、术后二次开胸、输血量与患者OPCABG术后中枢神经系统并发症发生率相关。年龄、术后心律失常、单侧或双侧颈动脉重度狭窄及闭塞是出现术后中枢神经系统并发症的独立危险因素。颈动脉重度狭窄患者,术前对颈动脉进行处理不会降低此类患者术后中枢神经系统并发症发生率。

Objective To analyze the effect of carotid artery stenosis degree and intervention for carotid artery stenosis on the incidence of central nervous system complications after off-pump coronary artery bypass grafting(OPCABG)and explore the influencing factors.Methods A total of 1150 patients undergoing OPCABG in our hospital from June 2018 to June 2021 were selected and divided into two groups according to whether there were central nervous system complications,including a central nervous system complication group[n=61,43 males and 18 females with a median age of 68.0(63.0,74.0)years]and a non-central nervous system complication group[n=1089,796 males and 293 females with a median age of 65.5(59.0,70.0)years].The risk factors for central nervous system complications after OPCABG were analyzed.Results Univariate analysis showed that age,smoking,hyperlipidemia,preoperative left ventricular ejection fraction,intra-aortic ballon pump(IABP),postoperative arrhythmia,postoperative thoracotomy and blood transfusion volume were associated with central nervous system complications.The incidence of central nervous system complications in patients with severe carotid artery stenosis or occlusion(11.63%)was higher than that in the nonstenosis and mild stenosis patients(4.80%)and moderate stenosis patients(4.76%)with a statistical difference(P=0.038).The intervention for carotid artery stenosis before or during the operation did not reduce the incidence of central nervous system complications after the operation(42.11%vs.2.99%,P<0.001).Age,postoperative arrhythmia,severe unilateral or bilateral carotid artery stenosis and occlusion were independent risk factors for postoperative central nervous system complications(P<0.05).Conclusion The age,smoking,hyperlipidemia,preoperative left ventricular ejection fraction,intraoperative use of IABP,postoperative arrhythmia,secondary thoracotomy after surgery,blood transfusion volume and OPCABG are associated with the incidence of postoperative central nervous system complications in patients.Age,postoperative arrhythmia,severe unilateral or bilateral carotid artery stenosis and occlusion are independent risk factors for postoperative central nervous system complications.In patients with severe carotid artery stenosis,preoperative treatment of the carotid artery will not reduce the incidence of central nervous system complications.