| Objective:To study the effect of carotid artery stenosis on the incidence of central nervous system complications after off-pump coronary artery bypass grafting,and analyze whether preoperative intervention for carotid artery stenosis can reduce the incidence of neurological complications after OPCABG and improve the prognosis,And explore the influencing factors of postoperative central nervous system complications in OPCABG patients.Methods:A retrospective analysis was conducted to extract 1150 OPCABG patients from the heart Center of our hospital from 06.01,2018 to 06.30,2021.06.30.According to the occurrence of postoperative central nervous system complications,the patients were divided into two groups.Acquisition in patients with preoperative basic information(age,sex,body mass index(bmi),preoperative heart left ventricular ejection fraction,the degree of carotid stenosis,etc.),the intraoperative situation(whether intraoperative use of IABP,operation time,blood vessels anastomosis count,etc.),the postoperative situation(whether postoperative arrhythmia,whether secondary surgery and blood transfusion,etc.)on the single factor analysis of Risk factors were identified and data were analyzed using statistical software SPSS,To determine the impact of carotid artery intervention on the incidence of postoperative central nervous system complications,and finally to determine the independent risk factors for new postoperative central nervous system complications in OPCABG patients using multivariate Logistic regression analysis.Consequence:Among the 1150 patients with coronary heart disease with carotid artery stenosis,61patients(5.30%)had postoperative central nervous system complications,including 13patients(1.13%)with cerebral infarction and diffuse ischemic hypoxic encephalopathy,and 48 patients(4)with mental abnormalities(cognitive dysfunction,manic restlessness,mental depression,and indifference).17%).In univariate analysis,age,smoking,hyperlipidemia,preoperative left ventricular ejection fraction,intraoperative need for IABP,postoperative arrhythmia,postoperative secondary thoracotomy,and blood transfusion volume(roughly represented by blood cost)were associated with the incidence of central nervous system complications.The incidence of central nervous system complications in patients with severe carotid artery stenosis or occlusion(11.63%)was significantly higher than that in patients with no stenosis,mild stenosis(4.79%)and moderate stenosis(4.76%).Preoperatively or intraoperatively all interventions in patients with asymptomatic carotid stenosis did not reduce the incidence of postoperative central nervous system complications in these patients.Multivariate regression analysis showed that age,postoperative arrhythmia,unilateral or bilateral severe carotid artery stenosis or even occlusion were independent risk factors for postoperative central nervous system complications in these patients(all P<0.05).Conclusion:The incidence of postoperative central nervous system complications in patients with age,smoking,hyperlipidemia,preoperative left ventricular ejection fraction,intraoperative use of IABP,postoperative arrhythmia,secondary thoracotomy after surgery,blood transfusion volume,and OPCABG Correlation Age,postoperative arrhythmia,severe unilateral or bilateral carotid artery stenosis and occlusion are independent risk factors for postoperative central nervous system complications.In patients with severe carotid artery stenosis,preoperative treatment of the carotid artery will not reduce the incidence of central nervous system complications in such patients.Meaning:Older age,postoperative arrhythmia,is in the central nervous system complications postoperatively in patients with coronary heart disease(CHD)independent risk factors,for elderly patients,ready to perioperative,decrease the risk of surgery,for postoperative arrhythmia,to find out the cause,maintain the stability of internal environment,timely treatment,in order to ensure the stability of hemodynamics,Thus reducing the risk of central nervous system complications.For CHD patients with carotid artery stenosis but no clinical symptoms of carotid artery stenosis,simultaneous or non-simultaneous treatment of carotid artery problems(only including carotid endarterectomy and carotid artery stent implantation)will not reduce the risk of postoperative central nervous system complications in such patients clinically.It may be necessary to adopt more targeted examination methods and treatment measures,such as preoperative MRA to detect cerebral blood flow,evaluate collateral circulation,and preventive superficial temporal artery to middle cerebral artery anastomosis for patients with insufficient cerebral blood flow reserve,which can reduce the incidence of postoperative complications to a certain extent.Secondly,the management indications,surgical methods and timing of carotid artery stenosis also need to be further studied and explored... |
