单主动脉阻断与部分主动脉阻断技术对冠状动脉搭桥手术术后中风的影响。

Effects of single aortic clamping versus partial aortic clamping techniques on post-operative stroke during coronary artery bypass surgery.

作者信息

Uyar Ihsan Sami, Akpinar Mehmet Besir, Sahin Veysel, Abacilar Feyzi, Yurtman Volkan, Okur Faik Fevzi, Ozdemir Ugur, Ates Mehmet

机构信息

Department of Cardiovascular Surgery, Medical Faculty, Sifa University Izmir, Turkey.

出版信息

Cardiovasc J Afr. 2013 Jul;24(6):213-7. doi: 10.5830/CVJA-2013-038.

DOI:10.5830/CVJA-2013-038

PMID:24217261

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3767939/

Abstract

BACKGROUND

The aim of this study was to compare the effects of single-clamping and partial-clamping techniques on postoperative stroke during coronary artery bypass surgery.

METHODS

Between December 2008 and December 2012, 2 000 patients who underwent coronary artery bypass grafting in two hospitals were analysed. Post-operative neurological complications were analysed retrospectively in these patients. The cases were divided into two groups: in group 1, 1 500 patients were analysed, in whom proximal anastomosis was performed with partial clamping in a beating heart (n = 1 500, 846 male, 654 female; mean age 63.25 ± 5.72 years; range 43-78 years). In group 2, 500 patients were analysed, in whom proximal anastomosis had been performed by other surgical teams in another hospital, with cross clamping in a resting heart with cardioplegia (n = 500, 296 male, 214 female; mean age 64.83 ± 8.12 years; range 41-81 years). During 30 days post-operatively, neurological deficits, stroke incidence and the relationship of the clinical situation to mortality were analysed.

RESULTS

For both groups, patients were similar in terms of patient characteristics. In group 2, cross-clamp duration and perfusion time were longer; however, time of hospital stay was similar in the two groups. Post-operative stroke was seen in 26 patients in group 1 (1.73%) and in nine in group 2 (1.8%). The difference between the two groups was not statistically significant (p = 0.92). All stroke patients were over the age of 55 years. Seven of the stroke patients died (21.1%). In total, 31 patients died because of multiple organ failure in the postoperative 30 days (group 1: 1.6%; group 2: 1.4%) (p = 0.91). Smoking, diabetes mellitus, hypertension, atrial fibrillation, peripheral vascular disease and hypercholesterolaemia were found to be factors that affected stroke development. Mean duration of hospital stay was 5.1 ± 2.8 days in group 1 and 4.9 ± 3.6 days in group 2 and the difference between the two groups was not statistically significant (p = 0.46).

CONCLUSION

In patients without plaques in the aorta, performing partial clamping did not increase stroke incidence.

摘要

背景

本研究旨在比较单钳夹技术和部分钳夹技术对冠状动脉搭桥手术术后中风的影响。

方法

2008年12月至2012年12月期间，对在两家医院接受冠状动脉搭桥术的2000例患者进行分析。对这些患者的术后神经并发症进行回顾性分析。病例分为两组：第1组，分析1500例患者，其中在跳动心脏下进行部分钳夹以完成近端吻合术（n = 1500，男846例，女654例；平均年龄63.25±5.72岁；范围43 - 78岁）。第2组，分析500例患者，这些患者在另一家医院由其他手术团队进行手术，在心脏停搏下进行交叉钳夹（n = 500，男296例，女214例；平均年龄64.83±8.12岁；范围41 - 81岁）。在术后30天内，分析神经功能缺损、中风发生率以及临床情况与死亡率的关系。

结果

两组患者在患者特征方面相似。第2组的交叉钳夹持续时间和灌注时间更长；然而，两组的住院时间相似。第1组有26例患者发生术后中风（1.73%），第2组有9例（1.8%）。两组之间的差异无统计学意义（p = 0.92）。所有中风患者年龄均超过55岁。7例中风患者死亡（21.1%）。术后30天内共有31例患者因多器官功能衰竭死亡（第1组：1.6%；第2组：1.4%）（p = 0.91）。吸烟、糖尿病、高血压、心房颤动、外周血管疾病和高胆固醇血症被发现是影响中风发生的因素。第1组的平均住院时间为5.1±2.8天，第2组为4.9±3.6天，两组之间的差异无统计学意义（p = 0.46）。