心血管手术患者术后神经系统并发症的发生率和分布:单中心回顾性分析

IF 0.2 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Kumar Rahul, Pankaj Garg, Suresh Kumar, Satish Kumar, Bhupendra Kumar, Sarvesh Kumar, Vivek Tewarson
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Materials and Methods: We retrospectively analyzed all the NCCT heads of the postoperative cardiovascular surgery patients done in the immediate and early postoperative period (<7 days) who developed postoperative neurological deficits between April 2016 and February 2020. The medical records of all these cardiac surgery patients were analyzed for various variants such as the total number of patients who underwent CS, various types of cardiac surgery done during the study period, demographic information, associated comorbidities, various types of NC, postoperative data and various spectrum of computed tomography (CT) findings in the brain. Results: A total of 12,896 adult and pediatric cardiac surgeries were performed at our institute. Out of these, 1115 patients (8.6%) underwent CT brain for suspected neurological injury. A total of 215 patients (1.6%) had a positive finding on their NCCT head. 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引用次数: 0

摘要

背景:尽管在围手术期监测和管理方面取得了进展,但神经系统并发症(脑卒中)仍然是心血管外科手术后的一种破坏性并发症。与心血管手术(CS)相关的NC发病率相对非常高,并伴有高发病率和死亡率。本研究的目的是评估成人和儿童患者的神经系统并发症的总体发生率,以及与各种类型的CS相关的非对比ct头部(NCCT)的各种神经损伤模式。材料与方法:我们回顾性分析2016年4月至2020年2月期间发生术后神经功能缺损的所有心血管手术术后即刻和早期(<7天)患者的NCCT头部。对所有这些心脏手术患者的医疗记录进行各种变量分析,如接受CS的患者总数、研究期间进行的各种心脏手术类型、人口统计信息、相关合并症、各种NC类型、术后数据和大脑的各种计算机断层扫描(CT)结果。结果:我院共完成成人及儿童心脏手术12,896例。其中1115例(8.6%)患者因疑似神经损伤行颅脑CT检查。共有215例(1.6%)患者的NCCT头部有阳性发现。215例患者中,148例(68.9%)为成人患者,67例(31.1%)为儿科患者。156例(72.5%)患者出现缺血性梗死(卒中),59例(27.4%)患者出现出血性病变。各类CT阳性表现为缺血性梗死156例(72.5%),脑实质出血20例(9.3%),硬膜下出血16例(7.4%),蛛网膜下腔出血15例(6.9%),脑血管血栓01例(0.4%),脑室内出血07例(3.2%)。在1例成人患者中,缺血性梗死类型包括大脑中动脉(MCA)区域42例(41.5%),脑后区域34例(33.6%),脑前区域7例(7.0%),多区域梗死11例(11.0%),全脑缺血6例(6.0%)。17例(11.4%)出现肺实质内出血。在儿童患者亚群中,缺血性梗死的模式包括30例(54.5%)患者的全身缺氧损伤(GHI), 9例(16.3%)患者的大脑后动脉区域,8例(14.5%)患者的大脑中动脉区域,5例(9.0%)患者的多区域受累,3例(5.4%)患者的大脑前动脉区域。出血组5例(7.4%)发生蛛网膜下腔出血(SAH)。结论:在成人患者中,梗死组常见的是MCA区域亚群梗死,而出血组常见的是实质内出血(IPH)。在儿童患者亚群中,GHI常见于梗死组,SAH常见于出血组。此外,头部NCCT对心血管手术术后早期神经系统并发症的诊断和相应的并发症处理非常有用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Incidence and distribution of various arterial territories involved in postoperative neurological complications in patients undergoing cardiovascular surgery: A single centre retrospective analysis
Background: Neurological complications (NCs) (stroke) remain a devastating complication after cardiovascular surgical procedures despite advances in perioperative monitoring and management. The incidence of NC related to cardiovascular surgeries (CS) is comparatively very high and associated with high morbidity and mortality. The aim of this study is to evaluate the overall incidence of neurological complications in adult as well as pediatric patients and various pattern of neurological injury on noncontrast computed tomography head (NCCT) associated with various types of CS. Materials and Methods: We retrospectively analyzed all the NCCT heads of the postoperative cardiovascular surgery patients done in the immediate and early postoperative period (<7 days) who developed postoperative neurological deficits between April 2016 and February 2020. The medical records of all these cardiac surgery patients were analyzed for various variants such as the total number of patients who underwent CS, various types of cardiac surgery done during the study period, demographic information, associated comorbidities, various types of NC, postoperative data and various spectrum of computed tomography (CT) findings in the brain. Results: A total of 12,896 adult and pediatric cardiac surgeries were performed at our institute. Out of these, 1115 patients (8.6%) underwent CT brain for suspected neurological injury. A total of 215 patients (1.6%) had a positive finding on their NCCT head. Out of 215 patients, 148 (68.9%) were adult patients, whereas 67 (31.1%) were pediatric patients. A total of 156 (72.5%) patients had ischemic infarction (stroke), whereas hemorrhagic lesions were present in 59 patients (27.4%). The various types of positive CT scan findings were-156 ischemic infarcts (72.5%), 20 intraparenchymal hemorrhages (9.3%), 16 subdural hemorrhage (7.4%), 15 subarachnoid hemorrhage (6.9%), 01 cerebrovascular thrombosis (0.4%), and 07 intraventricular hemorrhage (3.2%). In an adult patient, pattern of ischemic infarct comprised middle cerebral artery (MCA) territory in 42 patients (41.5%), posterior territory in 34 patients (33.6%), anterior cerebral territory in seven patients (7.0%), multi-territory infracts in 11 patients (11.0%) and global ischemia in six patients (6.0%). Intraparenchymal hemorrhage was present in 17 patients (11.4%). In a pediatric subset of patient, the pattern of ischemic infarct included global hypoxic injury (GHI) in 30 patients (54.5%), posterior cerebral artery territory in nine patients (16.3%), MCA territory in eight patients (14.5%), multi-territory involvement in five patients (9.0%), and anterior cerebral artery territory in three patients (5.4%). In the hemorrhage group, five patients (7.4%) developed subarachnoid hemorrhage (SAH). Conclusion: In an adult patient, subset MCA territory infarcts were common in the infract group, whereas intra parenchymal haemorrhage (IPH) in the hemorrhage group. In the pediatric patient subset, GHI was common in infract group and SAH in hemorrhage group. Moreover, NCCT of the head is very useful in diagnosing early postoperative neurological complications in cardiovascular surgeries and managing the complications accordingly.
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来源期刊
Research in Cardiovascular Medicine
Research in Cardiovascular Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-
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