脑梗死患者冠状动脉旁路移植术后神经功能障碍

目的 探讨老年脑梗死患者非体外循环冠状动脉旁路移植术(OPCABG)后神经功能障碍的临床特点.方法 将术前有脑梗死的择期≥60岁的OPCABG患者108例作为研究组,随机择期术前无脑梗死病史≥60岁的OPCABG患者108例作为对照组,对照组手术时间与研究组相近,年龄相差5岁以内,同一组手术医生.结果 研究组术后神经功能障碍发生率明显高于对照组(27.8%与4.6%,OR=6.269,95%CI2.218～17.717,P＜0.01).神经功能障碍表现为谵妄22例及缺血性卒中8例,术后卒中均发生在术后24 h以后;研究组术后ICU时间及住院时间明显长于对照组[分别为(26.5±16.4)h与(21.6±8.8)h,(23.6±9.2)d与(19.4±5.7)d,P＜0.01].结论 在老年非体外循环冠状动脉旁路移植手术患者中,术前具有脑梗死者较无脑梗死者更易发生术后神经功能障碍,如谵妄及卒中,其ICU及住院时间均延长.

Abstract：

Objective To study neurologic injury after off-pump coronary artery bypass grafting (OPCABG) in elder patients with a history of stroke. Methods 108 patients (age≥60years) undergoing elective OPCABG with a history of stroke were studied. Each study patient was matched with 1 control patient who had no stroke history and was undergoing elective OPCABG either immediately before or immediately after the study patients by the same surgeon. Preoperative characteristics, ICU stay, hospital stay, hospital mortality, postoperative neurologic injury were compared in the two groups. Results The incidence of neurologic injury after operation among the study group was higher than those in control group (P＜0.01)(27.8% vs 4.6%). The incidence of delirium and stroke after operation among the study group was higher than those in control group(P＜0.05) (20.4% vs 3.7% ,7.4% vs 0.9%) ;The study group took longer to stay in ICU and hospital than the control group [(26.5±16.4)h vs (21.6±8.8)h ,(23.6±9.2)d vs(19.4±5.7)d, P＜0.01]. Logistic regression analysis showed that the risk factors of neurologic injury after OPCABG included previous stroke (OR 6. 269, 95% CI 2. 218-17. 717), age (OR 1.131,95% CI 1.032-1.239), hypertension (OR 5.072,95% CI 1. 420-18. 114) and diabetes (OR 2. 652,95% CI 1. 123-6. 260). Stroke after the operations was found in 8 of 108 study patients and included cerebral infarction in 6 and transient ischemic attack in 2. 8 patients had late stroke (＞ 24 hours).Conclusion The eldely patients with previous stroke undergoing OPCABG are more likely to have neurologic injury after operations, these patients had longer stays in ICU and hospital.

Neurologic injury after off-pump coronary artery bypass grafting in elder patients with a history of cerebral infarction

Objective To study neurologic injury after off-pump coronary artery bypass grafting (OPCABG) in elder patients with a history of stroke. Methods 108 patients (age≥60years) undergoing elective OPCABG with a history of stroke were studied. Each study patient was matched with 1 control patient who had no stroke history and was undergoing elective OPCABG either immediately before or immediately after the study patients by the same surgeon. Preoperative characteristics, ICU stay, hospital stay, hospital mortality, postoperative neurologic injury were compared in the two groups. Results The incidence of neurologic injury after operation among the study group was higher than those in control group (P＜0.01)(27.8% vs 4.6%). The incidence of delirium and stroke after operation among the study group was higher than those in control group(P＜0.05) (20.4% vs 3.7% ,7.4% vs 0.9%) ;The study group took longer to stay in ICU and hospital than the control group [(26.5±16.4)h vs (21.6±8.8)h ,(23.6±9.2)d vs(19.4±5.7)d, P＜0.01]. Logistic regression analysis showed that the risk factors of neurologic injury after OPCABG included previous stroke (OR 6. 269, 95% CI 2. 218-17. 717), age (OR 1.131,95% CI 1.032-1.239), hypertension (OR 5.072,95% CI 1. 420-18. 114) and diabetes (OR 2. 652,95% CI 1. 123-6. 260). Stroke after the operations was found in 8 of 108 study patients and included cerebral infarction in 6 and transient ischemic attack in 2. 8 patients had late stroke (＞ 24 hours).Conclusion The eldely patients with previous stroke undergoing OPCABG are more likely to have neurologic injury after operations, these patients had longer stays in ICU and hospital.