开放期刊系统

冠脉搭桥患者脑血管病变特征与术后早期神经系统并发症的相关性研究

郑 洁, 徐 流金, 倪 良春

摘要

冠状动脉旁路移植术(CABG)作为冠心病重要治疗手段,术后神经系统并发症严重影响患者预后与生活质量。
本综述全面梳理 CABG 患者脑血管病变特征和术后早期神经系统并发症的相关性研究。在脑血管病变特征方面,颅内动脉
狭窄、脑小血管病等病变,被认为是影响术后神经系统状况的危险因素。术后神经系统并发症涵盖缺血性脑卒中、认知功
能障碍、谵妄及癫痫发作等症状。大量研究表明,术前存在严重颈动脉狭窄、既往脑卒中 /TIA 病史,以及脑血流灌注储
备能力低下的患者,术后发生神经系统并发症的风险显著升高。此外,术中血压波动、体外循环相关的手术因素等,也会
通过影响脑血管病变进程,间接增加并发症风险。尽管目前已有诸多研究,但在不同脑血管病变特征量化评估与并发症精
准预测模型构建、多因素交互作用机制,以及针对性防治策略优化等方面,仍存在研究空白与挑战。未来需进一步整合多
模态影像学、血流动力学监测等技术,开展大规模前瞻性研究,为临床精准防治提供更坚实的理论依据与实践指导。

关键词

CABG;脑血管病变;神经系统并发症;MRA

全文:

PDF


参考

[1] 北京神经科学学会脑心共患病专业委员会 . 冠状动

脉旁路移植术围术期神经系统并发症评估与管理专家共识

[J]. 中国循环杂志 ,2025,40(2):105-123.

[2] 曹 芳 , 刘 珺 宇 , 郭 雨 欣 , 等 . 环 指 蛋 白 213 基 因 变

异与血管相关疾病关系的研究进展 [J]. 中国脑血管病杂

志 ,2024,21(05):341-348.

[3]Brinjikji, Waleed et al. “Cerebrovascular Manifestations

of Hereditary Hemorrhagic Telangiectasia.” Stroke vol. 46,11

(2015): 3329-37.

[4] 江波兰 , 颜小焰 , 李青 , 等 . 分析经颅多普勒超声

TCD 在健康体检中筛查颅内动脉狭窄的应用价值 [J]. 系统医

学 ,2017,2(23):82-84.

[5] 杨九龙 , 于涛 , 薛付忠 . 脑血管狭窄患者狭窄分布及

筛查模型的建立 [J]. 山东大学学报 ( 医学版 ),2021,59(11):114-

119+122.

[6]Luchowski P, Wojczal J, Buraczynska K, Kozlowicz M,

Stazka J, Rejdak K. Predictors of intracranial cerebral artery

stenosis in patients before cardiac surgery and its impact on

perioperative and long-term stroke risk. Neurol Neurochir Pol.

2015;49(6):395-400.

[7]Tsunekawa T, Sawada M, Kato T, et al. The Prevalence

and Distribution of Occlusive Lesions of the Cerebral Arteries in

Patients Undergoing Coronary Artery Bypass Graft Surgery. Semin

Thorac Cardiovasc Surg. 2018;30(4):413-420.

[8] 张金磊 , 苑杨 . 颅内动脉粥样硬化性狭窄临床分型、

危险因素及发病机制的研究进展 [J]. 实用心脑肺血管病杂

志 ,2025,33(05):129-132+140.

[9] 刘奇龙 . 磁共振血管成像在缺血性脑血管疾病诊

断方面的应用价值分析 [J]. 现代医学与健康研究电子杂

志 ,2022,6(11):114-117.

[10]Goldstone AB, Bronster DJ, Anyanwu AC, et al.

Predictors and outcomes of seizures after cardiac surgery: a

multivariable analysis of 2 578 patients[J]. Ann Thorac Surg,

2011, 91(2): 514-518.

[11]Teller J, Gabriel MM, Schimmelpfennig SD, et al. Stroke,

seizures, hallucinations and postoperative delirium as neurological

complications after cardiac surgery and percutaneous valve

replacement[J]. J Cardiovasc Dev Dis, 2022, 9(11): 365.

[12]Tschernatsch M, Juenemann M, Alhaidar F, et al.

Epileptic seizure discharges in patients after open chamber

cardiac surgery-a prospective prevalence pilot study using

continuous electroencephalography[J]. Intensive Care Med, 2020,

46(7): 1418- 1424.

[13]Roach GW, Kanchuger M, Mangano CM, et al. Adverse

cerebral outcomes after coronary bypass surgery[J]. N Engl J Med,

1996, 335(25): 1857-1863.

[14]Sharma V, Katznelson R, Jerath A, et al. The association

between tranexamic acid and convulsive seizures after cardiac

surgery: a multivariate analysis in 11 529 patients[J]. Anaesthesia,

2014, 69(2): 124-130.

[15]Manji RA, Grocott HP, Leake J, et al. Seizures following

cardiac surgery: the impact of tranexamic acid and other risk

factors[J]. Can J Anaesth, 2012, 59(1): 6-13.

[16]Takagi H, Ando T, Umemoto T, et al. Seizures associated

with tranexamic acid for cardiac surgery: a meta-analysis of

randomized and non-randomized studies[J]. J Cardiovasc Surg

(Torino), 2017, 58(4): 633-641.

[17]Murkin JM, Falter F, Granton J, et al. High-dose

tranexamic acid is associated with nonischemic clinical seizures in

cardiac surgical patients[J]. Anesth Analg, 2010, 110(2): 350-353.

[18]Greaves D, Psaltis PJ, Ross TJ, et al. Cognitive outcomes

following coronary artery bypass grafting: a systematic review and

metaanalysis of 91 829 patients[J]. Int J Cardiol, 2019, 289: 43-

49.

[19]Moller JT, Cluitmans P, Rasmussen LS, et al. Long-

term postoperative cognitive dysfunction in the elderly ISPOCD1

study[J]. Lancet, 1998, 351(9106): 857-861.

[20]Doraiswamy PM, Babyak MA, Hennig T, et al. Donepezil

for cognitive decline following coronary artery bypass surgery: a

pilot randomized controlled trial[J]. Psychopharmacol Bull, 2007,

40(2): 54-62.

[21]Hshieh TT, Yang T, Gartaganis SL, et al. Hospital

Elder Life Program: systematic review and meta-analysis of

effectiveness[J]. Am J Geriatr Psychiatry, 2018, 26(10): 1015-

1033.

[22]Efthimiou J, Butler J, Woodham C, et al. Diaphragm

paralysis following cardiac surgery: role of phrenic nerve cold

injury[J]. Ann Thorac Surg, 1991, 52(4): 1005-1008.

[23]O’Brien JW, Johnson SH, VanSteyn SJ, et al. Effects

of internal mammary artery dissection on phrenic nerve perfusion

and function[J]. Ann Thorac Surg, 1991, 52(2): 182-188.

[24]DeVita MA, Robinson LR, Rehder J, et al. Incidence and

natural history of phrenic neuropathy occurring during open heart

surgery[J]. Chest, 1993, 103(3): 850-856.

[25]Sharma AD, Parmley CL, Sreeram G, et al. Peripheral

nerve injuries during cardiac surgery: risk factors, diagnosis,

prognosis, and prevention[J]. Anesth Analg, 2000, 91(6): 1358-

1369.


(0 摘要 Views, 0 PDF Downloads)

Refbacks

  • 当前没有refback。