心脏及大血管外科术后中枢神经系统并发症及相关危险因素分析

Analysis of central nervous system complications and related risk factors after cardiac and large vascular surgery

目的探讨心脏及大血管外科术后中枢神经系统并发症的临床特点及相关危险因素。方法总结上海交通大学附属新华医院2017年1月至2022年12月行心脏及大血管外科手术的患者资料,统计其术后中枢神经系统并发症的发生及相关因素。结果1990例患者术后发生中枢神经系统并发症的共有122例,其中脑梗塞24例,脑出血9例,谵妄55例,癫痫抽搐4例,严重认知功能障碍30例。单因素logistic回归分析结果显示,高龄、外周血管疾病,既往卒中史、体外循环时间长,围术期低心排量、术后低氧血症、围术期心房颤动(房颤)是术后发生中枢神经系统并发症的相关危险因素。其中,高龄、围术期低心排量、围术期房颤三个因素呈高度相关。结论中枢神经系统疾病是心脏及大血管外科术后可能发生的最严重的并发症之一,对存在高危因素者需早期预防,及时发现,及时处理,以保障手术成功率并改善预后。

Objective To explore the clinical characteristics and related high-risk factors of complications of the postoperative central nervous system complications of heart and large vascular surgery.Methods The information of patients with cardiac and large vascular surgery at Xinhua Hospital Affiliated to Shanghai Jiao Tong University from January 2017 to December 2022 was summarized,and the occurrence of complications and related factors of the complications of the central nervous system were counted.Results There were 122 cases of complications of the central nervous system in 1990 cases,including 24 cases of cerebral infarction,9 cases of cerebral bleeding,55 cases of delirium,4 cases of epilepsy and convulsions and 30 cases of severe cognitive dysfunction.The results of univariate logistic regression analysis showed that the elderly,peripheral vascular disease,previous stroke history,long cardiopulmonary bypass time,perioperative low cardiac output,postoperative hypoxemia and perioperative atrial fibrillation were the relevant risk factors for the postoperative central nervous system complications.Among them,elderly age,perioperative low cardiac output and perioperative atrial fibrillation were highly correlated.Conclusion Central nervous system disease is one of the most serious complications after cardiac and vascular surgery.It is necessary to prevent,detect and treat the high risk factors as early as possible,to ensure the success rate of the surgery and improve the prognosis.