| Purpose: To study the relative risk factors, clinical manifestation, lab results,imaging, treatment and prognosis of perioperative cerebral infarction in cardiac andvascular surgery.Methods: This study retrospectively analyze34cases of heart-vascular surgery,perioperative cerebral infarction in patients with clinical data in our hospital fromJanuary2008to December2012, and combining with discussing literature. Mainobservation projects include: gender, age, Past medical history, general situation andoperation condition, blood biochemical examination before and after surgery (whiteblood cell count, platelet count, fibrinogen and INR), cerebral infarction onset time,clinical symptoms, Nerve function defect score (NIHSS) and Glasgow score,24~72hours of skull CT and/or MRI+DWI examination results, Number of days in hospital,BI score discharged etc.Results: This group of34patients including18males,16females. Ages are33to75years old, average61.79±10.57years old. Prior cerebrovascular disease in15cases; History of coronary heart disease in27cases; The history of atrial fibrillation in8cases; Hypertension in25cases; History of diabetes in8cases; Smoking in12cases.This group of34patients: the percutaneous coronary angiography in5cases,percutaneous coronary intervention in6cases, coronary artery bypass grafting in11cases, endovascular arotic repair in2cases, single valve replacement in1case,multiple valvular surgery in5cases,4cases of CABG combined valvular surgery.There are7cases of emergency operation,27cases of elective surgical procedures.Cerebral infarction onset time:6cases on the day of surgery,8cases on1daypostoperatively,4cases on2day postoperatively,4cases on3day postoperatively,3cases on4day postoperatively,4cases on5day postoperatively,2cases on8daypostoperatively,1case on9day postoperatively,2cases on11day postoperatively. Clinical manifestation: partial paralysis in23cases, partial body feels obstacle in12cases, aphasia in16cases, hemianopsia in10cases, gaze palsy in6cases, disturbanceof consciousness in9cases. By skull CT or MRI+DWI confirmed: anterior circulationinfarction in21cases, posterior circulation infarction in7cases, watershed areainfarction in3cases, anterior and posterior circulation infarction in3cases.27cases ofNIHSS score for2~15points.7cases of patients Glasgow coma score is4~12points.The patients adopt comprehensive therapy, giving free radical scavenger, vasodilator,promoting blood circulation to remove blood stasis drugs, the brain cell activator andso on. Length of stay is5~46days, average22.68±10.46days.6cases in dischargewithout disability, mild-to-moderate disability in14cases, severe disabilities in8cases,deterioration of automatic discharge in2cases,3cases died.Conclusion:1, This study suggests that the main risk factors of perioperativecerebral infarction include: old age, previous coronary heart disease, cerebrovasculardisease, hypertension, atrial fibrillation, history of diabetes, smoking, other factorsinclude general anesthesia and prolonged surgery operation, cardiopulmonary bypass.2,34cases with cerebral infarction occurred during11days postoperatively, of which22cases (65.8%) occurred during3days postoperatively. It suggests: most perioperativestroke occured in the early postoperative period and the incidence rate decreasedgradually as the time passed.3,34cases conform cerebral embolism in18cases(52.94%); hypoperfusion of cerebral infarction in7cases (20.59%); large arteryatherosclerotic cerebral infarction in5cases (14.71%); the lacunar infarction4cases(11.76%). It suggests: mechanism of cardiac surgery-related stroke mainly areembolism and hypoperfusion.4, Laboratory information in34cases include peripheralblood WBC, FIB level were significantly higher (all P <0.001) than that preoperatively,suggesting that the systemic inflammatory response secondary and hypercoagulablestate postoperatively may be relevant with perioperative stroke.5, In34cases theaverage length of stay was22.68±10.46d. When discharged BI is severe disabilitiesin8cases (23.53%), deterioration of automatic discharge in2cases (5.88%), death in3cases (8.82%). It suggests: perioperative stroke seriously affected the patient’sprognosis and quality of life, resulting in increased hospital days and increased burdenon the social and family, should be given active prevention and treatment. |
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