心脏外科手术后并发脑梗死的临床特征及影响因素

Clinical features and influencing factors of intercurrent cerebral infarction after cardiac surgery

  • 摘要:
      目的  分析心脏外科手术后并发脑梗死的临床特征及影响因素。
      方法  收集2017年8月—2019年12月在本院行心脏外科手术的364例患者的临床资料,其中术后发生脑梗死32例。将32例脑梗死患者依据手术方法的不同分为体外循环组(n=12)和非体外循环组(n=20),分析术后发生脑梗死的相关影响因素。
      结果  体外循环组大面积梗死、双侧梗死及皮层梗死发生率依次为58.33%、41.67%、8.33%,非体外循环组依次为15.00%、5.00%、45.00%,差异有统计学意义(P < 0.05)。单因素分析结果显示,脑梗死组与非脑梗死组在年龄、高血压、糖尿病、术后低血压以及房颤等方面比较,差异有统计学意义(P < 0.05);多因素Logistic回归分析结果显示,年龄、高血压、糖尿病、术后低血压以及房颤是心脏外科手术后并发脑梗死的独立危险因素(OR=2.932、2.328、2.069、1.243、1.990,P < 0.05)。
      结论  采取体外循环手术者并发脑梗死多为大面积梗死、双侧梗死,而非体外循环手术后并发脑梗死多为皮层梗死;年龄、高血压、糖尿病、术后低血压以及房颤是心脏外科手术后并发脑梗死的独立危险因素。

     

    Abstract:
      Objective  To analyze the clinical features and influencing factors of intercurrent cerebral infarction after cardiac surgery.
      Methods  Clinical materials of 364 patients with cardiac surgeries in authors'hospital from August 2017 to December 2019 were collected, and 32 cases had cerebral infarction after operations. According to the different operation methods, 32 patients with cerebral infarction were divided into extracorporeal circulation group (n=12) and non-extracorporeal circulation group (n=20), and the related factors of cerebral infarction after operations were analyzed.
      Results  The incidence rates of large area infarction, bilateral infarction and cortical infarction in the extracorporeal circulation group were 58.33%, 41.67% and 8.33% respectively, which showed significant differences when compared to 15.00%, 5.00% and 45.00% in the non-extracorporeal circulation group (P < 0.05). Univariate analysis showed that there were significant differences in age, hypertension, diabetes, postoperative hypotension and atrial fibrillation between cerebral infarction group and non-cerebral infarction group (P < 0.05). Multivariate Logistic regression analysis showed that age, hypertension, diabetes, postoperative hypotension and atrial fibrillation were the independent riskfactors for cerebral infarction after cardiac surgery (OR=2.932, 2.328, 2.069, 1.243, 1.990, P < 0.05).
      Conclusion  The types of intercurrent cerebral infarction in patients with extracorporeal circulation surgery are mostly large area infarction and bilateral infarction, while the type of intercurrent cerebral infarction in patients with non-extracorporeal circulation surgery is mostly cortical infarction. Age, hypertension, diabetes, postoperative hypotension and atrial fibrillation are the independent risk factors of cerebral infarction after cardiac surgery.

     

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