影像科学与光化学 ›› 2020, Vol. 38 ›› Issue (2): 362-367.DOI: 10.7517/issn.1674-0475.191006

• 综述与论文 • 上一篇    下一篇

心脏外科手术后脑梗死患者的影像学特点及相关因素分析

拜合提亚尔·克然木1, 李剑2, 张大权1   

  1. 1. 新疆维吾尔自治区人民医院 重症医学二科, 新疆 乌鲁木齐 830000;
    2. 新疆维吾尔自治区人民医院 心外科监护室, 新疆 乌鲁木齐 830000
  • 收稿日期:2019-10-09 出版日期:2020-03-15 发布日期:2020-03-15
  • 基金资助:
     

Imaging Characteristics and Related Factors of Patients with Cerebral Infarction after Cardiac Surgery

BAHTIYAR·keram1, LI Jian2, ZHANG Daquan1   

  1. 1. Department of Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang, P. R. China;
    2. Cardiac Surgery Care Unit, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang, P. R. China
  • Received:2019-10-09 Online:2020-03-15 Published:2020-03-15
  • Supported by:
     

摘要: 本文对心脏外科手术后脑梗死患者的影像学特点及发生脑梗死的相关因素进行探讨。选取本院心脏外科手术患者286例作为研究对象,术后34例发生脑梗死,按照手术方式的不同将脑梗死患者分为体外循环组(11例)和非体外循环组(23例),比较两组术后脑梗死的影像学特点,并对心脏外科手术后脑梗死的影响因素进行分析。研究发现,两组穿支梗死、分水岭梗死、多发梗死、陈旧梗死的发生率比较,差异无统计学意义(P>0.05);体外循环组皮层梗死的发生率明显低于非体外循环组,体外循环组大面积梗死、双侧梗死的发生率明显高于非体外循环组,差异有统计学意义(P<0.05)。经单因素分析,性别、空腹血糖、TC、TG、LDL-C、Hcy、吸烟、饮酒不是心脏外科手术后脑梗死的影响因素(P>0.05),年龄、文化程度、高血压病史、糖尿病为心脏外科手术后脑梗死的影响因素(P<0.05),经多因素二元Logistic回归分析,年龄高、文化程度低、高血压病史≥ 10、有糖尿病,是心脏外科手术后脑梗死的独立影响因素(P<0.05)。结果显示,体外循环手术常为大面积梗死、双侧梗死,症状较重,而非体外循环手术常为皮层梗死,且两者分水岭梗死较多,均与栓塞和低灌注有关。心脏外科手术后脑梗死与年龄高、文化程度低、高血压病史≥ 10、有糖尿病密切相关,早期给予针对性预防干预可能降低脑梗死的发生。

 

关键词: 心脏外科手术, 脑梗死, 影像学特点, 相关因素

Abstract: The imaging features of cerebral infarction patients after cardiac surgery and related factors of cerebral infarction were discussed. 286 cases of cardiac surgery patients were selected as the study subjects. 34 cases of cerebral infarction occurred after operation. According to different surgical methods, the patients with cerebral infarction were divided into 11 cases of cardiopulmonary bypass group and 23 cases of non-extracorporeal circulation group. The imaging features of postoperative cerebral infarction were compared between the two groups, and the influencing factors of cerebral infarction after cardiac surgery were analyzed. The results showed that there was no significant difference in the incidence of perforation, watershed infarction, multiple infarction, and old infarction between the two groups (P>0.05). The incidence of cortical infarction in the extracorporeal circulation group was significantly lower than that in the non-extracorporeal circulation group. The incidence of large infarction and bilateral infarction in the extracorporeal circulation group was significantly higher than that in the non-extracorporeal circulation group, and the difference was statistically significant (P<0.05). Univariate analysis showed that gender, fasting blood glucose, TC, TG, LDL-C, Hcy, smoking, and drinking were not the influencing factors of cerebral infarction after cardiac surgery (P>0.05); age, education level, history of hypertension, diabetes as heart Influencing factors of cerebral infarction after surgery (P<0.05); multivariate binary logistic regression analysis, high age, low education, history of hypertension ≥ 10, diabetes was an independent influencing factor of cerebral infarction after cardiac surgery (P< 0.05). This article shows that extracorporeal circulation surgery is often a large area of infarction, bilateral infarction, heavier symptoms, non-extracorporeal circulation surgery is often cortical infarction, and both watershed infarction, more related to embolism and hypoperfusion. Cerebral infarction after cardiac surgery is closely related to high age, low level of education, history of hypertension ≥ 10, and diabetes. Early targeted prevention intervention may reduce the incidence of cerebral infarction.

Key words: cardiac surgery, cerebral infarction, imaging features, related factors

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