心脏手术后脑梗死的危险因素分析

doi:10.3969/j.issn.1006-7795.2021.06.002

首都医科大学学报 ›› 2021, Vol. 42 ›› Issue (6): 909-914.doi: 10.3969/j.issn.1006-7795.2021.06.002

• 重症医学基础与临床研究 • 上一篇下一篇

心脏手术后脑梗死的危险因素分析

胡文莉¹, 侯登榜², 王粮山², 贾明², 来永强³, 侯晓彤², 王红^2*

1.空军特色医学中心超声诊断科,北京 100142;
2.首都医科大学附属北京安贞医院心外ICU,北京 100029;
3.首都医科大学附属北京安贞医院心脏外科中心,北京 100029

收稿日期:2021-09-10 出版日期:2021-12-21 发布日期:2021-12-17
基金资助:
国家重点研发计划(2018YFE9102500),北京市医院管理中心临床医学发展专项(ZYLX202111),北京市医院管理中心“登峰”计划(FDL20190601)。

Risk factors of cerebral infarction after cardiac surgery

Hu Wenli¹, Hou Dengbang², Wang Liangshan², Jia Ming², Lai Yongqiang³, Hou Xiaotong², Wang Hong^2*

1. Ultrasound Diagnostic Department, Air Force Medical Center, PLA, Beijing 100142, China;
2. Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;
3. Center for Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

Received:2021-09-10 Online:2021-12-21 Published:2021-12-17
Contact: * E-mail: wanghong@mail.ccmu.edu.cn
Supported by:
Mega-projects of Science and Technology Research of China (2018YFE9102500), Beijing Hospitals Authority Clinical Medicine Development of Special Funding (ZYLX202111), Beijing Hospitals Authority “Ascent Plan” (FDL20190601).

摘要/Abstract

摘要： 目的探讨包含颈动脉超声参数的心脏外科手术后患者住院期间发生脑梗死的风险因素。方法回顾性分析首都医科大学附属北京安贞医院2020年1月-2020年12月住院手术的491例成人患者资料,选择其中诊断为脑梗死的患者为病例组(脑梗死组),诊断为非脑梗死的患者为对照组(非脑梗死组)。采用单因素和多因素Logistic回归分析风险因素。结果心脏外科手术后患者在住院期间脑梗死的总发生率为1.8%,并发脑梗死患者的住院存活率约为77.8%。欧洲心血管手术危险因素评分(European System for Cardiac Operative Risk Evaluation, EuroSCORE) Ⅱ高(OR=1.585,95%CI:1.043~2.409)、双侧颈+椎动脉均有斑块(OR=14.513,95% CI:2.538~82.978)、体外膜氧合(extracorporeal membrane oxygenation, ECMO)辅助(OR=112.518, 95% CI:8.967~1 411.907)和术后新发心房颤动(以下简称房颤)(OR=20.800,95% CI:3.639~118.902)是心脏手术后脑梗死的独立风险因素。结论 EuroSCORE Ⅱ高、ECMO辅助和术后新发房颤之外,颈动脉超声发现双侧颈动脉和椎动脉斑块是心脏外科术后并发脑梗死的风险因素,有必要实施心脏术前颈动脉超声筛查并对有风险的患者严格术中、术后管理。

关键词: 颈动脉超声, 心脏手术, 重症监护室, 脑梗死, 风险

Abstract: Objective To investigate the risk factors of in-hospital cerebral infarction with carotid artery ultrasound parameters for postcardiotomy patients. Methods The data of 491 adult patients who underwent cardiac surgery in Beijing Anzhen Hospital, Capital Medical University from January 2020 to December 2020 were retrospectively analyzed. The patients were divided into cerebral infarction and control group. The risk factors were analyzed via univariate and multivariate Logistic regression. Results The total incidence of in-hospital cerebral infarction in postcardiotomy patients was 1.8%, and the survival rate of patients complicated with cerebral infarction was 77.8%. The higher European system for cardiac operative risk evaluation (EuroSCORE) II level (OR=1.585, 95%CI: 1.043-2.409), bilateral cervical and vertebral artery plaques (OR=14.513, 95%CI: 2.538-82.978), extracorporeal membrane oxygenation (ECMO) support (OR=112.518, 95%CI: 8.967-1 411.907), and new postoperative atrial fibrillation (OR=20.800, 95%CI: 3.639-118.902) were independent risk factors for cerebral infarction after cardiac surgery. Conclusion Besides higher EuroSCORE II, ECMO support and new-oneset postoperative atrial fibrillation, the carotid ultrasound-based bilateral carotid artery and vertebral artery plaques is risk factor for cerebral infarction after cardiac surgery. It is necessary to carry out a preoperative carotid artery ultrasound screening and strict intraoperative and postoperative management for the patients at risk.

Key words: carotid ultrasound, cardiac surgery, intensive care unit, cerebral infarction, risk factor

中图分类号:

R730.41

胡文莉, 侯登榜, 王粮山, 贾明, 来永强, 侯晓彤, 王红. 心脏手术后脑梗死的危险因素分析[J]. 首都医科大学学报, 2021, 42(6): 909-914.

Hu Wenli, Hou Dengbang, Wang Liangshan, Jia Ming, Lai Yongqiang, Hou Xiaotong, Wang Hong. Risk factors of cerebral infarction after cardiac surgery[J]. Journal of Capital Medical University, 2021, 42(6): 909-914.

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心脏手术后脑梗死的危险因素分析

Risk factors of cerebral infarction after cardiac surgery

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