Engelman D T, Cohn L H, Rizzo R J
Brigham & Women's Hospital, Boston, MA 02115, USA.
Heart Surg Forum. 1999;2(3):242-5.
Neurologic complications account for some of the most devastating problems following coronary artery bypass surgery. In this study we determined the incidence and predictors of perioperative transient ischemic attacks (TIAs) and strokes in patients undergoing coronary artery bypass grafting at our institution.
Data was prospectively collected from 4,518 consecutive patients undergoing isolated coronary artery bypass grafting at Brigham & Women's Hospital between 1993 and 1997.
One hundred and twenty of the 4,518 patients sustained either a TIA (30 patients, 0.7%) or a stroke (90 patients, 2.0%), for an overall incidence of 2.7%. Significant univariate predictors of TIA/stroke included a history of: 1) cerebral vascular disease, 2) peripheral vascular disease, 3) diabetes, 4) renal failure, 5) preoperative myocardial infarction, 6) hypertension, and 7) age > 70 years. Multivariate logistic regression analysis revealed the following significant associations (incidence of TIA/stroke, odds ratio): 1) cerebral vascular disease (6.4%, OR 2.5); 2) peripheral vascular disease (5.3%, OR 1.6); 3) renal failure (5.6%, OR 1.6); 4) myocardial infarction (3.2%, OR 1.5); 5) diabetes (3.7%, OR 1.5); 6) age > 70 (3.5%, OR 1.5). Perioperative TIA/stroke was significantly associated with postoperative low cardiac output and atrial fibrillation. Patients with TIA/stroke had a significantly longer ICU stay (4 vs. 2 median days), length of hospitalization (14 vs. 7 median days), and higher mortality rate (22% vs. 2.6%).
Perioperative TIA/stroke occurred in less than 3% of patients following coronary artery bypass grafting but was associated with significant mortality. The strongest predictors were cerebral and peripheral vascular disease.
神经系统并发症是冠状动脉搭桥手术后一些最具破坏性的问题。在本研究中，我们确定了在我们机构接受冠状动脉搭桥手术患者围手术期短暂性脑缺血发作（TIA）和中风的发生率及预测因素。
前瞻性收集了1993年至1997年间在布莱根妇女医院连续接受单纯冠状动脉搭桥手术的4518例患者的数据。
4518例患者中有120例发生了TIA（30例，0.7%）或中风（90例，2.0%），总发生率为2.7%。TIA/中风的显著单因素预测因素包括以下病史：1）脑血管疾病；2）外周血管疾病；3）糖尿病；4）肾衰竭；5）术前心肌梗死；6）高血压；7）年龄>70岁。多因素逻辑回归分析显示以下显著相关性（TIA/中风发生率，比值比）：1）脑血管疾病（6.4%，OR 2.5）；2）外周血管疾病（5.3%，OR 1.6）；3）肾衰竭（5.6%，OR 1.6）；4）心肌梗死（3.2%，OR 1.5）；5）糖尿病（3.7%，OR 1.5）；6）年龄>70岁（3.5%，OR 1.5）。围手术期TIA/中风与术后低心排血量和房颤显著相关。发生TIA/中风的患者在重症监护病房（ICU）的停留时间显著更长（中位数分别为4天和2天）、住院时间更长（中位数分别为14天和7天），且死亡率更高（分别为22%和2.6%）。
冠状动脉搭桥手术后不到3%的患者发生围手术期TIA/中风，但与显著的死亡率相关。最强的预测因素是脑血管和外周血管疾病。
