合并颈动脉狭窄的冠状动脉搭桥发生围手术期缺血性脑卒中的常见因素分析
发布时间：2018-08-23 21:07
【摘要】：目的:分析同时合并有颈动脉疾病的冠心病患者围手术期发生缺血性脑卒中的常见因素,以提高对该类疾病的治疗效果。方法:收集2008年至2014年厦门大学附属第一医院收治的44例多支冠状动脉病变合并颈动脉狭窄的患者,其中男性32例,女性12例。所有患者在处理颈部病变后再接受冠状动脉旁路移植术。对其手术效果及随访结果进行回顾性分析。结果:1例接受颈动脉内膜剥脱术的患者术后出现偏瘫,经治疗后临床症状改善。短暂性脑缺血发作1例,5例患者在术后1周再发脑血管后循环梗死。12例患者术后48 h内出现神经损伤表现。早期使用主动脉内球囊反搏9例,二次开胸止血1例,胸骨哆开3例;术后早期出现心房颤动27例。总计死亡2例。随访1~7年,随访率为90%,44例患者脑缺血症状获得不同程度的改善。6例患者诉心绞痛症状再发,但复查冠状动脉造影或冠状动脉CT血管造影无异常发现,随访期间1例患者因恶性肿瘤死亡。结论:接受冠状动脉搭桥手术的患者一旦合并颈动脉疾病,其缺血性脑卒中发生的概率更高,但颈动脉狭窄并不是该类患者发生围手术期卒中的唯一原因,其他危险因素同样不容忽视。
[Abstract]:Objective: to analyze the common factors of ischemic stroke in patients with coronary artery disease associated with carotid artery disease in order to improve the therapeutic effect. Methods: from 2008 to 2014, 44 patients (32 males and 12 females) with multi-vessel coronary artery disease complicated with carotid artery stenosis were collected from the first affiliated Hospital of Xiamen University. All patients underwent coronary artery bypass grafting after treatment of cervical lesions. The results of operation and follow-up were analyzed retrospectively. Results one patient who received carotid endarterectomy had hemiplegia after operation and the clinical symptoms were improved after treatment. 1 case with transient ischemic attack and 5 cases with recurrent cerebral vascular posterior circulation infarction in 1 week after operation. 12 cases developed nerve injury within 48 h after operation. Early intraaortic balloon counterpulsation was used in 9 cases, second thoracotomy in 1 case, sternum in 3 cases, atrial fibrillation in 27 cases. A total of 2 cases died. Follow-up for 1 ~ 7 years, the follow-up rate was 90 and 44 patients with cerebral ischemia symptoms improved in varying degrees. 6 patients complained of angina pectoris symptoms recurrence, but re-examination of coronary angiography or coronary artery CT angiography found no abnormal. One patient died of malignant tumor during follow-up. Conclusion: patients undergoing coronary artery bypass grafting are more likely to have ischemic stroke once they are associated with carotid artery disease, but carotid stenosis is not the only cause of perioperative stroke. Other risk factors cannot be ignored.
【作者单位】： 中南大学湘雅二医院心血管外科;厦门大学附属第一医院心脏外科;
【分类号】：R743.3;R654.2
[Abstract]:Objective: to analyze the common factors of ischemic stroke in patients with coronary artery disease associated with carotid artery disease in order to improve the therapeutic effect. Methods: from 2008 to 2014, 44 patients (32 males and 12 females) with multi-vessel coronary artery disease complicated with carotid artery stenosis were collected from the first affiliated Hospital of Xiamen University. All patients underwent coronary artery bypass grafting after treatment of cervical lesions. The results of operation and follow-up were analyzed retrospectively. Results one patient who received carotid endarterectomy had hemiplegia after operation and the clinical symptoms were improved after treatment. 1 case with transient ischemic attack and 5 cases with recurrent cerebral vascular posterior circulation infarction in 1 week after operation. 12 cases developed nerve injury within 48 h after operation. Early intraaortic balloon counterpulsation was used in 9 cases, second thoracotomy in 1 case, sternum in 3 cases, atrial fibrillation in 27 cases. A total of 2 cases died. Follow-up for 1 ~ 7 years, the follow-up rate was 90 and 44 patients with cerebral ischemia symptoms improved in varying degrees. 6 patients complained of angina pectoris symptoms recurrence, but re-examination of coronary angiography or coronary artery CT angiography found no abnormal. One patient died of malignant tumor during follow-up. Conclusion: patients undergoing coronary artery bypass grafting are more likely to have ischemic stroke once they are associated with carotid artery disease, but carotid stenosis is not the only cause of perioperative stroke. Other risk factors cannot be ignored.
【作者单位】： 中南大学湘雅二医院心血管外科;厦门大学附属第一医院心脏外科;
【分类号】：R743.3;R654.2
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