CAJ | 학술논문

背景:冠脉搭桥后神经系统并发症发病率较高,其发病原因是多因素的.目的:回顾性分析冠状动脉旁路移植后严重神经系统并发症的发生及其相关因素.方法:选择2002-09/2009-08南京市鼓楼医院冠脉搭桥患者761例,男443例,女318例,年龄32～89岁.按年龄(≥或<70岁)、体外循环冠脉搭桥或非体外循环下冠脉搭桥进行分组比较,使用统计学方法揭示神经系统并发症和其危险因素之间的关系.结果与结论:76例冠脉搭桥患者中41例患者术后发生严重神经系统并发症,其中≥70岁组22例(14.9%),<70岁组19例(3.1%),两组比较差异有非常显著性意义(P<0.001);体外循环冠脉搭桥组7例(5.3%),非体外循环下冠脉搭桥34例(5.4%),两组比较差异无显著性意义(P=0.39),实验还发现颈动脉狭窄>50%患者术后发生严重神经系统并发症概率较高;死亡8例,其中2例死于消化道大出血,1例死于严重感染,4例死于多脏器功能衰竭,1例死于术后癫痫持续发作.存活33例,平均随访3年,死亡3例.3例肢体活动障碍部分恢复,1例发生严重智力障碍.结果显示冠脉搭桥后神经系统并发症的发生受多因素影响,其中老龄(≥70岁),颈动脉狭窄为最重要的危险因素之一,体外循环和非体外循环对术后并发症的影响未见明显差异.
배경:관맥탑교후신경계통병발증발병솔교고,기발병원인시다인소적.목적:회고성분석관상동맥방로이식후엄중신경계통병발증적발생급기상관인소.방법:선택2002-09/2009-08남경시고루의원관맥탑교환자761례,남443례,녀318례,년령32～89세.안년령(≥혹<70세)、체외순배관맥탑교혹비체외순배하관맥탑교진행분조비교,사용통계학방법게시신경계통병발증화기위험인소지간적관계.결과여결론:76례관맥탑교환자중41례환자술후발생엄중신경계통병발증,기중≥70세조22례(14.9%),<70세조19례(3.1%),량조비교차이유비상현저성의의(P<0.001);체외순배관맥탑교조7례(5.3%),비체외순배하관맥탑교34례(5.4%),량조비교차이무현저성의의(P=0.39),실험환발현경동맥협착>50%환자술후발생엄중신경계통병발증개솔교고;사망8례,기중2례사우소화도대출혈,1례사우엄중감염,4례사우다장기공능쇠갈,1례사우술후전간지속발작.존활33례,평균수방3년,사망3례.3례지체활동장애부분회복,1례발생엄중지력장애.결과현시관맥탑교후신경계통병발증적발생수다인소영향,기중노령(≥70세),경동맥협착위최중요적위험인소지일,체외순배화비체외순배대술후병발증적영향미견명현차이.
BACKGROUND: Neurological complications after coronary artery bypass grafting still have a high incidence rate, and the etiology is multiple.OBJECTIVE: To retrospectively investigate the occurrence and relevant factors of severe neurological complications after coronary artery bypass grafting (CABG).METHODS: A total of 761 consecutive patients with undergoing CABG were included in this study from September 2002 to August 2009 at the Nanjing Drumtower Hospital, including 443 males and 318 females, aged from 32-89 years. All patients were grouped according to age(more than or less than 70-year-old) and on pump or off pump coronary surgery. Disclose the relationship between the risk factors and the neurological complications by statistics analysis.RESULTS AND CONCLUSION: Totally 41 patients had serious neurological complications in this study. There was a higher complication incidence in 570-year-old group patients (n=22) than < 70-year-old group (n=19)(14.9% vs. 3.1%, P< 0.001). The neurological complications incidence was similar in on-Pump CABG group (n =7) and off-Pump CABG group (n = 34) (5.3% vs.5.4%, P=0.39). The incidence rate of severe neurological complications was high in carotid artery stenosis > 50% patients. A total of 8 cases died, 2 for massive hemorrhage of gastrointestinal tract; 1 for severe sepsis; 4 for multiple organ dysfunction syndrome;1 for epilepsia gravior postoperatively. Finally, 33 cases survived. The average time of follow up was 3 years, 3 cases died, 3 cases recovery from limitation of limb or hand movement partly, and 1 case had severe mental retardation. Results displayed that elderly patients(= 70 years) undergoing CABG are at higher risk of neurological dysfunction. Carotid artery stenosis is the most risk factor. There are no significant effects on postoperative complications between on-pump CABG and off-pump CABG.