Wang Bin, Jia Ming, Jia Shijie, Wan Jiuhe, Zhou Xiao, Luo Zhimin, Zhou Ye, Zhang Jianqun
Department of Cardiac Surgery ICU, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.
Department of Cardiac Surgery ICU, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.
Heart Lung Circ. 2014 Jun;23(6):560-5. doi: 10.1016/j.hlc.2013.11.017. Epub 2014 Jan 22.
To analyse risk factors for early acute cerebrovascular accidents following off-pump coronary artery bypass grafting (OPCAB) in patients with stroke history, and to propose preventive measures to reduce the incidence of these events.
A total of 468 patients with a history of stroke underwent OPCAB surgery in Beijing Anzhen Hospital of China from January 2010 to September 2012. They were retrospectively divided into two groups according to the occurrence of early acute cerebrovascular accidents within 48 hours following OPCAB. Multivariate logistic regression analysis was used to find risk or protective factors for early acute cerebrovascular accidents following the OPCAB.
Fifty-two patients (11.1%) suffered from early acute cerebrovascular accidents in 468 patients, including 39 cases of cerebral infarction, two cases of cerebral haemorrhage, 11 cases of transient ischaemic attack (TIA). There were significant differences between the two groups in preoperative left ventricular ejection fraction ≤ 35%, severe bilateral carotid artery stenosis, poorly controlled hypertension, intraoperative application of Enclose® II proximal anastomotic device, postoperative acute myocardial infarction, atrial fibrillation, hypotension, ventilation time > 48h, ICU duration >48h and mortality. Multivariate logistic regression analysis showed that preoperative severe bilateral carotid stenosis (OR=6.378, 95%CI: 2.278-20.987) and preoperative left ventricular ejection fraction ≤ 35% (OR=2.737, 95%CI: 1.267-6.389), postoperative acute myocardial infarction (OR=3.644, 95%CI: 1.928-6.876), postoperative atrial fibrillation (OR=3.104, 95%CI:1.135∼8.016) and postoperative hypotension (OR=4.173, 95%CI: 1.836∼9.701) were independent risk factors for early acute cerebrovascular accidents in patients with a history of stroke following OPCAB procedures, while intraoperative application of Enclose® II proximal anastomotic device was protective factor (OR=0.556, 95%CI: 0.337-0.925).
This study indicated that patients with severe bilateral carotid stenosis, the left ventricular ejection fraction ≤35%, the postoperative acute myocardial infarction, postoperative atrial fibrillation and postoperative hypotension were more likely to suffer from early acute cerebrovascular accidents when they received OPCAB. Application of Enclose® II proximal anastomotic device may decrease the incidence of early acute cerebrovascular accidents during OPCAB.
分析有卒中病史患者非体外循环冠状动脉搭桥术（OPCAB）后早期急性脑血管意外的危险因素，并提出预防措施以降低这些事件的发生率。
2010年1月至2012年9月，共有468例有卒中病史的患者在北京安贞医院接受了OPCAB手术。根据OPCAB术后48小时内是否发生早期急性脑血管意外，将他们回顾性地分为两组。采用多因素logistic回归分析来寻找OPCAB后早期急性脑血管意外的风险或保护因素。
468例患者中有52例（11.1%）发生了早期急性脑血管意外，其中脑梗死39例，脑出血2例，短暂性脑缺血发作（TIA）11例。两组在术前左心室射血分数≤35%、双侧严重颈动脉狭窄、高血压控制不佳、术中应用Enclose® II近端吻合装置、术后急性心肌梗死、心房颤动、低血压、通气时间>48小时、ICU停留时间>48小时及死亡率方面存在显著差异。多因素logistic回归分析显示，术前双侧严重颈动脉狭窄（OR = 6.378，95%CI：2.278 - 20.987）、术前左心室射血分数≤35%（OR = 2.737，95%CI：1.267 - 6.389）、术后急性心肌梗死（OR = 3.644，95%CI：1.928 - 6.876）、术后心房颤动（OR = 3.104，95%CI：1.135 - 8.016）及术后低血压（OR = 4.173，95%CI：1.836 - 9.701）是有卒中病史患者OPCAB术后早期急性脑血管意外的独立危险因素，而术中应用Enclose® II近端吻合装置是保护因素（OR = 0.556，95%CI：0.337 - 0.925）。
本研究表明，有双侧严重颈动脉狭窄、左心室射血分数≤35%及术后发生急性心肌梗死、术后心房颤动和术后低血压的患者在接受OPCAB时更易发生早期急性脑血管意外。应用Enclose® II近端吻合装置可能会降低OPCAB期间早期急性脑血管意外的发生率。
