心源性缺血性脑卒中患者早期体外循环心脏手术

发布时间：2018-08-21 07:34

【摘要】：目的:探讨无昏迷心源性缺血性脑卒中患者早期行体外循环心脏手术的可行性。方法:回顾性分析北京军区总医院2000年1月至2015年12月68例无昏迷的心源性缺血性脑卒中患者接受体外循环心脏手术的临床资料,其中最近一次脑卒中距体外循环心脏手术的时间在1个月内的患者为A组,共计28例,其中风湿性二尖瓣狭窄伴慢性房颤有15例(合并左房血栓有14例)、感染性心内膜炎伴左侧心脏瓣膜赘生物7例(合并脑脓肿1例)、冠心病伴左心室壁瘤和附壁血栓4例、左房黏液瘤2例;最近一次脑卒中距体外循环心脏手术的时间超过1个月的患者为B组,共计40例,其中风湿性二尖瓣狭窄有20例(合并慢性房颤者17例,合并左房血栓者13例)、感染性心内膜炎伴左侧心脏瓣膜赘生物13例、左心室壁瘤5例(合并冠心病4例,伴有左室附壁血栓4例)、左房黏液瘤2例。对比两组患者体外循环时间、主动脉阻断时间、术后神经功能恶化情况、脑缺血出血转化情况、因神经系统并发症而死亡情况、术后延迟苏醒、术后延迟拔管、二次开胸止血、住ICU时间、住院费用、住院死亡率。结果:A组体外循环时间(116±47)min,B组体外循环时间(109±44)min,差异不显著(P0.05);A组主动脉阻断时间(68±35)min,B组主动脉阻断时间(65±34)min,差异不显著(P0.05);A、B组两组术后神经功能恶化率相等(0%),差异没有统计学意义(P0.05);A、B两组术后脑缺血出血转化率相等(0%),差异没有统计学意义(P0.05);A、B两组术后因神经系统并发症而发生的死亡率相等(0%),差异没有统计学意义(P0.05);A组术后延迟苏醒百分比10.7%,B组术后延迟苏醒百分比7.5%,差异不显著(P0.05);A组术后延迟拔管百分比14.3%,B组术后延迟拔管百分比5.0%,差异不显著(P0.05);A组术后二次开胸止血百分比3.6%,B组术后二次开胸止血百分比2.5%,差异不显著(P0.05);A组住院死亡率0%,B组住院死亡率0%,差异没有统计学意义(P0.05);A组术后住ICU时间(49±36)h,B组术后住ICU时间(42±22)h,差异不显著(P0.05);A组住院费用(125186±47968)元,B组住院费用(119364±48807)元,差异不显著(P0.05);A、B两组住院死亡率相等(0%),差异没有统计学意义(P0.05)。结论:无昏迷心源性缺血性脑卒中后早期接受体外循环心脏手术是可行的。
[Abstract]:Objective: to investigate the feasibility of cardiopulmonary bypass (CPB) in patients with ischemic stroke without coma. Methods: the clinical data of 68 patients with cardiogenic ischemic stroke without coma from January 2000 to December 2015 in Beijing military region General Hospital were retrospectively analyzed. Among them, the most recent stroke and the time of cardiopulmonary bypass heart surgery within one month were group A, a total of 28 patients, There were 15 cases of rheumatic mitral stenosis with chronic atrial fibrillation (14 cases with left atrial thrombosis), 7 cases of infective endocarditis with left cardiac valve neoplasm (1 case with brain abscess), 4 cases of coronary heart disease with left ventricular aneurysm and mural thrombus. Two cases of left atrial myxoma and 40 cases of patients with rheumatic mitral stenosis (17 cases with chronic atrial fibrillation) were found in group B, whose most recent stroke was more than one month after cardiopulmonary bypass (CPB). 13 cases were associated with left atrial thrombosis, 13 cases were infective endocarditis with left cardiac valve vegetations, 5 cases were left ventricular aneurysms (4 cases were complicated with coronary heart disease, 4 cases were associated with thrombus attached to left ventricle), 2 cases were left atrial myxoma. The time of cardiopulmonary bypass (CPB), the time of aortic occlusion, the deterioration of postoperative nerve function, the transformation of cerebral ischemic hemorrhage, the death due to complications of nervous system, the delayed recovery after operation, the delayed extubation after operation, the second thoracotomy and hemostasis were compared between the two groups. Time spent in ICU, hospitalization expenses, hospital mortality. Results the cardiopulmonary bypass time of group A was (116 卤47) min, the time of CPB was (109 卤44) min, the difference was not significant (P0.05). The time of aortic occlusion in group A was (68 卤35) min (65 卤34) min. The difference was not significant (P0.05). The deterioration rate of nerve function in group A was equal (0%), the difference was not statistically significant. The conversion rate of cerebral ischemia hemorrhage was equal (0%) between the two groups (P0.05). The mortality rate due to neurological complications in group A was equal (0%), and the difference was not statistically significant (P0.05) in group A (P 0.05). There was no significant difference (P0.05) in the percentage of delayed extubation after operation between group B and group B (P 0.05). The percentage of delayed extubation after operation in group A and group B was 5.0, and the difference was not significant (P0.05). The percentage of hemostasis after second thoracotomy in group A was 3.6%, and that in group B was 100 times after operation. The difference was not significant (P0.05). There was no significant difference in the mortality rate between group A and group B (P 0.05). The duration of ICU in group A was (49 卤36) h after operation, and the duration of ICU in group B was (42 卤22) h. The difference was not significant (P0.05). The hospitalization cost of group A was (125186 卤47968) yuan, that of group B was (119364 卤48807) yuan. There was no significant difference (P0.05) between the two groups (0%), the difference was not statistically significant (P0.05). Conclusion: cardiopulmonary bypass (CPB) is feasible in the early stage of ischemic stroke without coma.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R654.2

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