血液净化治疗急性中毒并发多器官功能障碍综合征82例临床观察

目的探讨血液净化治疗急性中毒并发多器官功能障碍综合征（MODS）的临床价值。方法治疗组82例在综合治疗的基础上,40例给予血液灌注（HP组）,42例用HP＋连续性静脉-静脉血液滤过（CVVH）治疗（HP＋CVVH组）。对照组86例仅给予综合治疗。结粜（1）治疗组机械通气时间（46．5±8．5）h,住院时间（10．5±3．5）d,治愈好转率91．5％（75／82）,病死率8．5％（5／82）;对照组分别为（59．5±11．5）h、（15．5±4．5）d、72．1％（62／86）及27．9％（24／86）。两组比较差异有统计学意义（P均〈0．01）。（2）HP＋CVVH组72h的肝功能、肾功能、炎性因子、APACHEⅡ评分指标比单纯HP组治疗明显改善（P均〈0．05）。（3）HP＋CVVH组的机械通气时间为（42．5±8．5）h,住院时间为（9．5±2．5）d,治愈好转率为97．6％（41／42）,病死率为2．4％（1／42）;HP组的机械通气时间为（50．5±9．5）h,住院时间为（11．5±3．5）d,治愈好转率为85．0％（34／40）,病死率为15％（6／40）,两组比较差异有统计学意义（P均〈0．05）。结论血液净化治疗急性中毒并发MODS,能从血液中直接、迅速地清除内外源性有害物质,疗效肯定,尤其HP＋CVVH治疗的疗效更为显著。     

老年急性心肌梗死并发糖尿病患者急诊介入治疗近期疗效

目的探讨老年急性心肌梗死（AMI）并发糖尿病患者急诊经皮冠状动脉介入治疗（PCI）的安全性。方法将316例老年（≥60岁）AMI患者分为糖尿病组（DM组，76例）和非糖尿病组（ND组，240例），于发病12h内行急诊PCI，比较两组患者临床和冠状动脉造影特征、PCI成功率及术后并发症发生率。结果（1）DM组患者血脂异常、空腹血糖水平、前壁AMI百分比均显著高于ND组[分别为42．1％和24．2％，（10±3）mmol／L和（5±2．1）mmol／L，68．4％和49．6％，P〈0．05]。（2）DM组患者的梗死相关血管为前降支者显著高于ND组（60．5％和42．1％，P〈0．05），DM组三支病变、弥漫病变率显著高于ND组（78．9％和46．3％，67．1％和46．3％，P〈0．01）。（3）PCI即刻成功率、术中无复流发生率、住院期间PCI术后并发症发生率和病死率两组比较差异均无统计学意义。结论急诊PCI治疗老年AMI并发糖尿病患者近期安全有效。     

急性心肌梗死住院患者并发肺炎的影响因素分析

目的探讨入院初期影响急性心肌梗死（AMI）患者并发肺炎的相关因素。方法以1993年1月至2006年6月收住解放军总医院的1443例AMI住院患者为对象，对比分析AMI合并肺炎组（159例）和非肺炎组（1284例）患者入院时的病史、临床表现、并发症等特点，以Logistic多因素逐步回归分析探讨AMI入院后并发肺炎的独立影响因素。结果Logistic多因素逐步回归分析表明年龄[比数比（0R）1．983，95％可信区间（CI）1．499-2．623]、冠心病病史（OR 1．566，CI 1．034～2．371）、入院时心率（OR 1．823，CI 1．452～2．287）、白细胞计数（OR 1．409，CI 1．071～1．853）、贫血（OR2．292，CI 1．482～3．543）、PCI治疗（OR 0．519，CI 0．327～0．824），并发心衰（OR3．264，CI 2．130～5．002）、室颤／室速（OR 2．347，CI 1．231～4．476）是AMI患者并发肺炎的独立影响因素。结论AMI患者入院时心率和白细胞计数升高，并发心衰、室颤／室速和贫血以及未进行PCI治疗者并发肺炎的危险性明显升高。     

不稳定型心绞痛与急性心肌梗死危险因素及冠状动脉造影病变特点的比较

根据临床和冠状动脉造影结果将122例冠心病患者分为不稳定型心绞痛（UA）组60例和急性心肌梗死（AMI）组62例，对UA与AMI危险因素及病变特点进行比较分析。结果：冠心病的危险因素年龄、高血压、高血脂、糖尿病和吸烟等在UA组及AMI组经统计学处理均无显著性差异（P＞0．05）。冠状动脉造影：单支病变在UA组明显多于AMI组，多支病变在UA组明显少于AMI组，两组间数据经统计学处理均有显著性差异（P＜0．05）；回旋支、右冠状动脉病变在AMI组明显高于UA组，两组间数据经统计学处理有显著性差异（P＜0．05）；完全阻塞和狭窄≥95％在AMI组明显高于UA组，两组间数据经统计学处理有显著性差异（P＜0．001和P＜0．005）。结论：冠心病的危险因素年龄、高血压、高血脂、糖尿病、吸烟及其病程与冠心病的病变程度无相关性；冠状动脉造影显示UA和AMI病变特点有显著性差异。     

呼吸机相关性肺炎的危险因素及病原学研究

目的：探讨呼吸机相关性肺炎（VAP）的危险因素及病原学特点,以指导临床治疗。方法：回顾性收集机械通气治疗时间〉48h的106例患者的病历资料,分析VAP的危险因素、病原菌及耐药性。结果：106例患者中VAP患者共48例（45．3%）。糖尿病、气管切开患者VAP的发病率增高（P〈0．05）;VAP组病死率明显高于无VAP组（P〈0．05）;VAP病原菌以革兰阴性菌为主（67．1％）,其中以铜绿假单胞菌为主要致病菌（21．9％）,绝大多数病原菌出现严重耐药。结论：多种临床因素与VAP的发病有关;VAP病原菌以革兰阴性菌为主,耐药率高;VAP的发生将严重影响患者的预后。     

急性心肌梗死介入治疗与静脉溶栓治疗的疗效观察

目的：比较急诊经皮冠状动脉介入治疗（直接PCI）与尿激酶（UK）静脉溶栓治疗对急性心肌梗死（AMI）患者近期的临床疗效。方法：首次发生的ST段抬高的AMI患者62例，其中30例患者接受直接PCI治疗（直接PCI组），32例患者接受UK静脉溶栓治疗（UK）组），两组均于发病6h内进行治疗，比较两组患者住院期间临床疗效及超声心动图检查结果。结果：两组院内死亡率无显著性差异P〉0．05。直接PCI组梗塞相关血管（IRA）再通率高于UK组（96．7％：62．5％），P〈0．05。临床疗效：直接PCI组再发梗塞、发生心肌缺血事件和心力衰竭比率明显低于UK组，（13．3％：34．4％），P〈0．05。二周后超声心动图显示，直接PCI组左室射血分数（LVEF）明显高于UK组（64．9±7．6）％：（49．1±7．3）％，P〈0．05，也明显高于UK组中溶栓成功组（64．9±7．6）％：（53．4±8．5）％，P〈0．05。结论：直接PCI是AMI早期再灌注安全有效的方法，能够提高IRA再通率，改善心功能，减少并发症。     

婴幼儿心内直视术后呼吸机相关性肺炎高危因素分析

目的探讨婴幼儿先天性心脏病（先心病）心内直视术后呼吸机相关性肺炎（VAP）的高危因素。方法回顾性分析2006年1月至2008年12月间入住浙江大学医学院儿童医院SICU的143例心内直视术后机械通气时间≥48h的先心病婴幼儿的病历资料。将143例婴幼儿分为两组：发生VAP的59例为VAP组,未发生VAP的84例为对照组。以性别、疾病类型、生长发育情况、贫血、血清球蛋白水平、术前抗生素应用情况、生长发育、机械通气时间、再插管、H2受体抑制剂或制酸剂应用等为预想危险因素进行单因素及多因素分析,明确婴幼儿心内直视术后与VAP相关的危险因素。结果婴幼儿先心病心内直视术后VAP的发生率为41．3％。单因素分析发现术前抗生素使用、体外循环（CPB）时间、机械通气时间、再插管、H2受体抑制剂或制酸剂应用、术后低心排、术后合并败血症这7个因素与VAP有关（P〈0．05）。多因素logistic回归分析显示术前抗生素使用、机械通气时间、再插管、H2受体抑制剂或制酸剂应用是婴幼儿先心病心内直视术后VAP的独立危险因素（P〈0．05）。结论婴幼儿先心病心内直视术后VAP发生率高,术前抗生素使用、机械通气时间、再插管、H2受体抑制剂或制酸剂应用是婴幼儿先心病心内直视术后VAP的独立危险因素,采取综合防治措施是控制VAP的最佳策略。     

早期PCI对急性心肌梗塞并发完全性右束支传导阻滞患者预后的影响

目的：探讨早期PCI对急性心肌梗塞（AMI）并发完全性右束支传导阻滞（CRBBB）患者预后的影响。方法：回顾分析AMI并发CRBBB患者36例的临床资料,分为两组,早期行PCI的12例为观察组,未行PCI的24例为对照组,对两组患者的左室射血分数（LVEF）、心功能Killip分级、严重恶性心律失常发生率及住院病死率等临床资料进行对比性分析,并做统计学处理。结果：观察组的心功能Killip分级[（1．7±0．5）级：（2．6±0．5）级]、严重恶性心律失常发生率（8．3％：20．8％）及住院病死率（8．3％：33．3％）均显著低于对照组（P〈0．01）,观察组的LVEF[（56．3±7．1）％：（32．6±4．7）％]显著高于对照组（P〈0．01）。结论：早期PCI可以改善急性心肌梗塞并发完全性右束支传导阻滞患者的预后。     

急性心肌梗死并发急性脑梗死危险因素及临床特点

目的 分析急性心肌梗死（AMI）并发急性脑梗死（AIS）的危险因素及临床特点。 方法 回顾性分析2010年1月~2015年4月我院收治住院的75例AMI并发AIS患者为病例组,随机选择同期住院的单纯AMI和单纯AIS患者各80例为对照组,对比分析3组临床资料。 结果 单因素分析显示,AMI并发AIS组与单纯AMI组比较,既往脑梗死病史、外周血管病史、血肌酐水平显著高于对照组,高密度脂蛋白胆固醇（HDL-C）显著低于对照组,差异有统计学意义（P<0.05）;与单纯AIS组比较,男性、既往心肌梗死病史、外周血管病史、血肌酐水平显著高于对照组,入院收缩压与舒张压显著低于对照组,差异有统计学意义（P<0.05）;多因素Logistic回归分析表明,男性、既往脑梗病史、血肌酐为AMI并发AIS的独立危险因素（P<0.05,OR>1）,入院舒张压为其保护性因素（P<0.01,OR<1）。临床特点分析表明,KILLIP分级≥Ⅱ级高于两对照组（44% vs. 16% vs. 1%,P<0.01）,多发脑梗死高于单纯AIS 组（46% vs. 16%,P<0.01）,PCI患者冠状动脉3支病变显著高于单纯AMI组（76% vs. 52%,P<0.05）。 结论 男性、入院舒张压降低、既往脑梗病史、血肌酐水平升高为AMI并发AIS的独立危险因素,心功能不全、多发脑梗死为其临床特点,冠状动脉3支病变为PCI术后并发急性脑梗死患者的临床特点。     

影响脑梗死后行机械通气患者撤机的危险因素分析

目的探讨影响脑梗死机械通气患者撤机的危险因素。方法需要机械通气的急性脑梗死患者38例,前瞻性观察机械通气前及撤机前的格拉斯哥昏迷量表（GCS）评分、生命体征、血液生化指标、浅快呼吸指数（RSBI）和血气分析等指标及其动态变化（用两者差值表示）。根据撤机后48h是否需要重新应用呼吸机分为失败组（9例）和成功组（29例）。结果①38例患者中29例成功撤机,9例失败,撤机失败组平均年龄高于成功组,肺部感染和消化道出血的比例亦高于成功组,差异均具有统计学意义,P〈0．01。②呼吸相关指标比较中,呼吸频率、RSBI和氧合指数等指标在成功组和失败组之间以及每组通气前和撤机前的比较中,差异均具有统计学意义,P〈0．05。两组撤机前与通气前的差值比较中,PaCO2、氧合指数和RSBI的差值比较具有统计学意义。③血常规和生化相关指标比较中,GCS评分、ALT等指标在成功组和失败组之间以及每组通气前和撤机前的比较中,差异均具有统计学意义,P〈0．05。两组撤机前与通气前的差值比较中GCS、体温、血小板等的差值比较具有统计学意义。④多因素分析结果表明,与撤机相关的独立因素为机械通气前后RSBI和GCS的差值,两者联合预测撤机成功的敏感性为93．1％,特异性为66．7％,准确性为86．8％。结论动态监测脑梗死机械通气患者的意识状态和浅快呼吸指数有助于对撤机时机的把握。     

Risk factors and effect of reperfusion therapy on left ventricular free wall rupture following acute myocardial infarction

Reperfusion therapy is one of the most effective treatments for acute myocardial infarction, but the effect on left ventricular free wall rupture remains to be determined. This study tried to clarify the risk factors and effect of reperfusion therapy on the risk of free wall rupture following acute myocardial infarction. 2,671 consecutive patients with acute myocardial infarction admitted to our hospital were examined. Incidence of free wall rupture showed no degenerative change(0 to 5.8%; mean 2.1%). The 1,269 consecutive patients from 1985 to 1995 were examined closely to evaluate risk factors and the effect of reperfusion therapy on the risk of free wall rupture. Fourteen patients who underwent emergent coronary artery bypass surgery were excluded. Free wall rupture was found in 25 patients (2.0%). Multivariate analysis confirmed that high age(> or = 70 years) and first acute myocardial infarction were independent risk factors of free wall rupture (odds ratio 3.62, p = 0.003; odds ratio 7.69, p = 0.046, respectively). The incidence of free wall rupture in the conservative therapy group(n = 799) was 2.1%, successful reperfusion group(n = 373) was 0.5%, and unsuccessful reperfusion group(n = 83) was 7.2% with significant statistical differences(p < 0.01). There was no statistical difference between the direct percutaneous transluminal coronary angioplasty group(n = 84, 3.6%) and the thrombolysis group(n = 372, 1.3%). Successful reperfusion was the only independent factor in the reperfusion therapy group that reduced the incidence of free wall rupture(odds ratio = 0.07, p = 0.001). We conclude that reperfusion of the infarct-related artery and more intensive management of unsuccessful reperfusion is important to prevent free wall rupture following acute myocardial infarction.     

急性ST段抬高心肌梗死急诊经皮冠状动脉介入治疗后心肌灌注不良的影响因素

目的:探讨急性ST段抬高心肌梗死(心梗)(STEMI)急诊经皮冠状动脉介入治疗(PCI)后心肌灌注不良的影响因素。方法:根据PCI后心肌梗死溶栓治疗(TIMI)心肌灌注分级(TMPG),91例患者分为心肌灌注不良组(TMPG0～2级,n=30)和心肌灌注正常组(TMPG3级,n=61),比较2组基本临床资料和造影结果以及介入结果,并对各因素进行Logistio回归分析,总结急性心梗急诊PCI后心肌灌注不良的影响因素。结果:91例患者中男76例,女15例,年龄38～84(62.3±11.8)岁,心肌灌注不良组合并高血压病的比例更高(80.0%比54.1%,P=0.0163),心梗部位以非前壁心梗居多(70.0%比29.5%,P=0.002);造影结果中,心肌灌注不良组梗死相关血管以右冠状动脉(RCA)更多见(63.3%比18.0%,P     

急性ST段抬高心肌梗死中心脏破裂的认识

目的：研究对急性ST段抬高心肌梗死中心脏破裂的认识。方法选择2010年10月-2011年12月,我院收治的急性ST段抬高心肌梗死患者150例,对患者的心脏破裂进行诊断,并根据诊断结果将150例患者分成12例心脏破裂组,138例无心脏破裂组。观察两组患者的性别,年龄,治疗使用的方法。结果在心脏破裂中,年龄、性别,治疗方法的不同对其均有影响（P〈0.05）。结论心脏破裂是急性ST段抬高心肌梗死中最严重的并发症,了解急性ST段抬高心肌梗死中出现心脏破裂的因素,为临床医生在治疗时提供有利依据,延长患者的生命。     

Influence of residual myocardial ischaemia on induced ventricular arrhythmias following a first acute myocardial infarction.

OBJECTIVES: The purpose of this study was to assess the possible effect of residual myocardial ischaemia on induced ventricular arrhythmia during programmed ventricular stimulation in survivors of a first acute myocardial infarction. BACKGROUND: Most deaths after hospital discharge for acute myocardial infarction are sudden and presumably arrhythmic. Sudden cardiac death results from a dynamic interaction of structural abnormalities and transient triggering factors. The role of myocardial ischaemia as a trigger for ventricular arrhythmias remains unclear. We hypothesized that residual myocardial ischaemia after a first acute myocardial infarction is a potent trigger for sustained ventricular tachyarrhythmias, particularly in the presence of an abnormal myocardium. METHODS AND RESULTS: In this prospective study, programmed electrical stimulation, coronary angiography and dipyridamole-thallium-201 scintigraphy single-photon emission computed tomography were performed in 90 consecutive survivors of a first acute myocardial infarction. Patients, divided in two groups - group 1 with induced ventricular tachyarrhythmia (n=24) and group 2 without induced ventricular tachyarrhythmia (n=66) - were compared regarding residual myocardial ischaemia. The two groups were comparable in terms of mean left ventricular ejection fraction, infarct size and location, gender ratio, peak creatine kinase value, and extent of coronary disease. Residual myocardial ischaemia was detected in 32 patients: 15 (42.5%) belonged to group 1 and 17 (25.7%) to group 2. There was a statistically significant difference between the two groups regarding the presence and the extent of residual myocardial ischaemia (P<0.05). CONCLUSION: Residual myocardial ischaemia, revealed by dipyridamole-thallium-201 scintigraphy following a first acute myocardial infarction, might contribute to electrical instability evaluated by programmed ventricular stimulation.     

首次急性ST段抬高与非ST段抬高心肌梗死患者临床及冠状动脉病变特点比较

目的回顾性分析比较首次发生急性ST段抬高心肌梗死与非ST段抬高心肌梗死的临床及冠状动脉病变的特点。方法选择首次急性ST段抬高心肌梗死患者50例(ST段抬高组)和急性非ST段抬高心肌梗死患者50例(非ST段抬高组),均行冠状动脉造影检查,对其发病特点、临床表现、并发症、心功能以及冠状动脉病变进行回顾性分析。结果 ST段抬高组起病急,主要以剧烈胸痛为主,就诊时间较早,非ST段抬高组首发症状多样。ST段抬高组总并发症、室性心律失常、窦性心动过缓及传导阻滞发生率明显高于非ST段抬高组(P<0.01),左心室射血分数明显低于非ST段抬高组(P<0.05)。与ST段抬高组比较,非ST段抬高组冠状动脉病变血管支数较多,3支病变、侧支循环比例较高(P<0.05,P<0.01)。结论急性ST段抬高心肌梗死起病急,并发症多,影响心功能,应积极尽快实施血运重建,以开通梗死相关血管,但急性非ST段抬高心肌梗死冠状动脉病变往往较重。急性心肌梗死的近期预后与起病急缓、透壁性心肌坏死范围等有关。     

急性前壁心肌梗死急诊介入治疗患者住院期间心力衰竭原因的分析

目的探讨急性前壁ST段抬高心肌梗死患者行急诊PCI后,发生心力衰竭的危险因素。方法回顾性研究初诊为急性前壁ST段抬高心肌梗死、并行急诊PCI的110例患者,根据是否有心力衰竭,分为心力衰竭组39例和非心力衰竭组71例,比较2组患者临床基础特征,应用logistic回归分析心力衰竭的危险因素。结果心力衰竭组与非心力衰竭组患者年龄、高血压、糖尿病、梗死前心绞痛、发病至手术时间、收缩压、入院血糖、白细胞计数、B型钠尿肽、β受体阻滞剂、术后TIMI血流比较,差异均有统计学意义(P<0.05,P<0.01)。发病至手术时间、年龄、入院血糖、高血压为心力衰竭的危险因素;梗死前心绞痛、术后TIMI血流为心力衰竭的保护因素。结论发病时间长、年龄大,血糖、血压等危险因素越多,术后TIMI血流差,患者心力衰竭的可能性越高。     

Impact of myocardial perfusion on left atrial remodeling following primary angioplasty for acute myocardial infarction

OBJECTIVES: To investigate the impact of myocardial perfusion on left atrial remodeling and its determinants after primary percutaneous coronary intervention for acute myocardial infarction. BACKGROUND: Left atrial volume is an important predictor of morbidity and mortality in acute myocardial infarction, while thrombolysis in myocardial infarction (TIMI) myocardial perfusion (TMP) grade is an angiographic index associated with infarct size and mortality. As yet, however, the relationship between TMP grade and left atrial remodeling has not been investigated. METHODS: Conventional transthoracic echocardiography was performed in 105 patients (55+/-13 years old, 92 men) with acute myocardial infarction within 24 h and after 6 months (mean 9+/-4, range 6-29 months) following successful primary percutaneous coronary intervention. Absolute left atrial volume was calculated using an elliptical model. Myocardial perfusion was evaluated, using TMP grade, by visual assessment on the coronary angiogram. Patients were divided into three groups on the basis of myocardial perfusion status, as TMP 0/1 (n=36), TMP 2 (n=36) and TMP 3 (n=33). RESULTS: No difference was observed between baseline and follow-up left atrial volumes in the overall study population (42.5+/-16.1 vs. 43.5+/-17.4 ml, P=0.519). As regards TMP grade, follow-up left atrial volume significantly increased in the TMP 0/1 group (43+/-17 vs. 54.6+/-1.1 ml, P<0.001) and significantly decreased in the TMP 3 group (42.9+/-15.7 vs. 35.5+/-12.2 ml, P=0.001) compared with initial values. No change was observed in left atrial volume in the TMP 2 group. Multivariate analysis showed that TMP grade (P<0.001) and anterior location of myocardial infarction (P<0.001) were independent determinants of left atrial remodeling. CONCLUSIONS: These results suggest that poor myocardial perfusion and anterior location of myocardial infarction can affect left atrial remodeling in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. It appears that adequate myocardial perfusion is crucial to prevent left atrial remodeling, a poor prognostic factor in acute myocardial infarction.     

Reduced incidence of left ventricular thrombi with intravenous streptokinase in acute anterior myocardial infarction: prospective evaluation by cross-sectional echocardiography

Forty-five consecutive patients with transmural anterior acute myocardial infarction were prospectively studied to determine the effect of intravenous streptokinase on the incidence of left ventricular thrombi. Three patients died. The remaining patients were divided into 2 groups. Group 1 patients (n = 22) received 750,000 units of intravenous streptokinase within 6 hours of onset of symptoms. Neither thrombolytic therapy or anticoagulants were administered to 18 patients in group 2. Cross-sectional echocardiography was performed 8 to 10 days following acute myocardial infarction to detect left ventricular thrombus. Technically satisfactory echocardiography was not possible in 2 patients. Apical akinesia or dyskinesia was observed in all patients. No patient in the treated group developed left ventricular thrombus compared with 8 of 18 (44.4%) in group 2 (P less than 0.05). One patient in the control group sustained an embolic cerebrovascular accident. Thus intravenous streptokinase significantly reduces the incidence of left ventricular thrombus formation in patients of transmural anterior acute myocardial infarction.     

延迟相缺血预处理心肌保护时间窗的临床探讨

目的探讨心肌梗死患者延迟相缺血预处理的心肌保护时间窗。方法行直接冠状动脉介入治疗的急性心肌梗死患者150例,根据梗死前心绞痛发作时间分为三组：无心绞痛组（1组）55例,〈72 h心绞痛组（2组）55例,〉72 h心绞痛组（3组）40例。统计患者一般临床情况、院内预后指标、出院前的左室射血分数,肌酸激酶和肌酸激酶同工酶的曲线下面积反映患者的心肌梗死面积。结果除年龄外,其余各项临床指标在三组间均无统计学差异。2组和3组的心肌梗死面积明显低于1组（P〈0.01）,但2组的充血性心力衰竭/休克、复合终点发生率明显低于1组和3组（P〈0.01或0.05）。梗死前心绞痛的心肌保护作用与年龄、抗心绞痛药物以及侧支循环无关。结论临床缺血预处理的保护时间窗不同于动物实验,可能大于72 h。     

伴卒中史患者非体外循环冠状动脉旁路移植术后再发急性脑梗死的影响因素分析

目的探讨伴有卒中史患者非体外循环冠状动脉旁路移植(OPCAB)术后再发急性脑梗死的相关因素。方法回顾性分析首都医科大学附属北京安贞医院2010年1月—2012年9月,468例有卒中史OPCAB手术患者的临床资料。根据术后有无再发急性脑梗死分为再发脑梗死组(A组)41例和无再发脑梗死组(B组)427例。分析与缺血事件发生的相关因素[术后再发脑梗死的时间为完成手术入住重症监护病房(ICU)期间]。结果 468例OPCAB手术患者术后再发急性脑梗死41例,占8.8%。①单因素分析显示,A、B组间术前双侧颈内动脉重度狭窄[(41.5%(17/41),8.9%(38/427)]、术前左心室射血分数≤35%[53.7%(22/41),25.8%(110/427)]、术中En-closeⅡ主动脉近端吻合器的应用[19.5%(8/41),76.3%(326/427)]、术后急性心肌梗死[34.1%(14/41),9.1%(39/427)]、术后心房颤动[48.8%(20/41),10.8%(46/427)]、术后低血压[68.3%(28/41),18.7%(80/427)]、术后机械通气时间>72 h[(75.6%(31/41),15.0%(64/427)]、入住ICU时间>72 h[(82.9%(34/41),25.3%(108/427)]及病死率[(29.3%(12/41),5.4%(23/427)],差异均有统计学意义(均P<0.01)。②多因素Logistic回归分析显示,术前双侧颈内动脉重度狭窄(OR=6.338,95%CI:2.283～21.019)、术前左心室射血分数≤35%(OR=2.737,95%CI:1.267～6.389)、术后急性心肌梗死(OR=3.656,95%CI:1.933～6.894)、术后心房颤动(OR=3.104,95%CI:1.135～8.016)与术后低血压(OR=4.173,95%CI:1.836～9.701)是OPCAB患者术后再发急性脑梗死的独立危险因素。术中应用EncloseⅡ主动脉近端吻合器(OR=0.556,95%CI:0.337～0.925)是OPCAB患者术后再发急性脑梗死的保护因素。结论伴有卒中史患者行OPCAB术后,再发急性脑梗死的发生率及病死率高,术前双侧颈内动脉重度狭窄、术前左心室射血分数≤35%、术后急性心肌梗死、术后心房颤动和术后低血压是伴有卒中史患者OPCAB术后再发急性脑梗死的独立危险因素。而术中应用EncloseⅡ主动脉近端吻合器是伴有卒中史患者OPCAB术后再发急性脑梗死的保护因素。