發(fā)布時(shí)間：2018-08-23 21:07

【摘要】：目的:分析同時(shí)合并有頸動(dòng)脈疾病的冠心病患者圍手術(shù)期發(fā)生缺血性腦卒中的常見因素,以提高對(duì)該類疾病的治療效果。方法:收集2008年至2014年廈門大學(xué)附屬第一醫(yī)院收治的44例多支冠狀動(dòng)脈病變合并頸動(dòng)脈狹窄的患者,其中男性32例,女性12例。所有患者在處理頸部病變后再接受冠狀動(dòng)脈旁路移植術(shù)。對(duì)其手術(shù)效果及隨訪結(jié)果進(jìn)行回顧性分析。結(jié)果:1例接受頸動(dòng)脈內(nèi)膜剝脫術(shù)的患者術(shù)后出現(xiàn)偏癱,經(jīng)治療后臨床癥狀改善。短暫性腦缺血發(fā)作1例,5例患者在術(shù)后1周再發(fā)腦血管后循環(huán)梗死。12例患者術(shù)后48 h內(nèi)出現(xiàn)神經(jīng)損傷表現(xiàn)。早期使用主動(dòng)脈內(nèi)球囊反搏9例,二次開胸止血1例,胸骨哆開3例;術(shù)后早期出現(xiàn)心房顫動(dòng)27例�？傆�(jì)死亡2例。隨訪1~7年,隨訪率為90%,44例患者腦缺血癥狀獲得不同程度的改善。6例患者訴心絞痛癥狀再發(fā),但復(fù)查冠狀動(dòng)脈造影或冠狀動(dòng)脈CT血管造影無異常發(fā)現(xiàn),隨訪期間1例患者因惡性腫瘤死亡。結(jié)論:接受冠狀動(dòng)脈搭橋手術(shù)的患者一旦合并頸動(dòng)脈疾病,其缺血性腦卒中發(fā)生的概率更高,但頸動(dòng)脈狹窄并不是該類患者發(fā)生圍手術(shù)期卒中的唯一原因,其他危險(xiǎn)因素同樣不容忽視。
[Abstract]:Objective: to analyze the common factors of ischemic stroke in patients with coronary artery disease associated with carotid artery disease in order to improve the therapeutic effect. Methods: from 2008 to 2014, 44 patients (32 males and 12 females) with multi-vessel coronary artery disease complicated with carotid artery stenosis were collected from the first affiliated Hospital of Xiamen University. All patients underwent coronary artery bypass grafting after treatment of cervical lesions. The results of operation and follow-up were analyzed retrospectively. Results one patient who received carotid endarterectomy had hemiplegia after operation and the clinical symptoms were improved after treatment. 1 case with transient ischemic attack and 5 cases with recurrent cerebral vascular posterior circulation infarction in 1 week after operation. 12 cases developed nerve injury within 48 h after operation. Early intraaortic balloon counterpulsation was used in 9 cases, second thoracotomy in 1 case, sternum in 3 cases, atrial fibrillation in 27 cases. A total of 2 cases died. Follow-up for 1 ~ 7 years, the follow-up rate was 90 and 44 patients with cerebral ischemia symptoms improved in varying degrees. 6 patients complained of angina pectoris symptoms recurrence, but re-examination of coronary angiography or coronary artery CT angiography found no abnormal. One patient died of malignant tumor during follow-up. Conclusion: patients undergoing coronary artery bypass grafting are more likely to have ischemic stroke once they are associated with carotid artery disease, but carotid stenosis is not the only cause of perioperative stroke. Other risk factors cannot be ignored.
【作者單位】： 中南大學(xué)湘雅二醫(yī)院心血管外科;廈門大學(xué)附屬第一醫(yī)院心臟外科;
【分類號(hào)】：R743.3;R654.2

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本文編號(hào)：2199916