冠心病合并重度颈动脉狭窄患者围术期常规血压管理策略

Perioperative routine blood pressure management for coronary heart disease patients with severe carotid stenosis

目的冠心病(coronary atherosclerotic heart disease,CAD)合并重度颈动脉狭窄的患者在围术期易出现心脑血管不良事件,严格的血压管理策略(收缩压<120 mmHg)能够降低冠心病患者不良事件的发生率,但严格降压策略对于合并重度颈动脉狭窄的患者造成的低灌注会增加脑卒中的风险。常规血压管理策略(120 mmHg<收缩压<140 mmHg)能够维持此类患者围术期足够的脑灌注,但心血管不良事件是否会因此增加尚不可知。因此本研究旨在探究常规血压管理策略对冠心病合并重度颈动脉狭窄接受非体外冠状动脉旁路移植术+颈动脉内膜剥脱(off-pump coronary artery bypass grafting,OPCABG;carotid endarteretomy,CEA)的患者是否安全有效,为明确此类患者围术期合理的血压管理方案提供实验依据。方法回顾性分析2019年6月至2021年5月间,北京安贞医院收治的55例接受OPCABG+CEA的冠心病合并重度颈动脉狭窄患者和155例接受OPCABG的单纯冠心病患者临床资料,两组患者围术期均采用常规血压管理策略,对比分析两组患者围术期神经系统及部分心血管并发症的发生情况。结果OPCABG+CEA组和OPCABG两组手术死亡各1例,原因均为多脏器功能衰竭。OPCABG+CEA组术后7例出现神经系统相关并发症,单纯OPCABG患者术后22例发生神经系统并发症,两组患者术后神经系统相关并发症的发生率无统计学差异(P>0.05)。两组患者围术期心肌梗死和新发房颤的发生率无统计学差异(P>0.05)。结论常规血压管理对同期行OPCABG+CEA的冠心病合并颈动脉重度狭窄的患者是安全有效的,不会增加神经系统相关并发症以及心血管不良事件的风险。

Objective Coronary atherosclerotic heart disease(CAD)patients with severe carotid stenosis have higher rate of cardio-cerebrovascular adverse events during perioperation.The intensive blood pressure management(SBP<120 mmHg)can reduce the rates of adverse events in CAD patients;however,the low perfusion results from intensive strategy may increase the risk of stroke in CAD patients with severe carotid stenosis.The recent study aim to study whether the standard blood pressure management strategy is safe and effective for CAD patients with severe carotid stenosis who receive off-pump coronary artery bypass grafting(OPCABG)and carotid endarterectomy(CEA).Methods The clinical data of 210 patients undergoing elective OPCABG between June 2019 and May 2021 in Beijing Anzhen Hospital affiliated of Capital Medical University were retrospectively analyzed,including 149 males and 61 females.According to the operation method,they were divided into two groups:OPCABG+CEA group(55 patients)and OPCABG group(155 patients).The perioperative curative effect of patients under conventional blood pressure management strategy was observed.Results One death occurred in the OPCABG+CEA group and one in the OPCABG group,both of which were caused by multiple organ failure.In the OPCABG+CEA group,7 postoperative neurological complications occurred;OPCABG group had 22 cases with nervous system complications.There was no significant difference in the incidence of postoperative neurological complications between the two groups(P>0.05).There was no significant difference in the incidence of perioperative myocardial infarction and new-onset atrial fibrillation between the two groups(P>0.05).Conclusions Routine blood pressure management and nursing strategies are safe and effective for patients with coronary heart disease and severe carotid artery stenosis undergoing OPCABG+CEA at the same time,and will not increase the risk of nervous system-related complications and cardiovascular adverse events.