The Coronary Artery Bypass Graft Surgery Under Extracorporeal Circulation Perioperative Risk Factors Analysis Of Ischemic Cerebral Apoplexy

Objective:To evaluate the risk factors of perioperative ischemic stroke in patients undergoing off-pump coronary artery bypass grafting(OPCABG),for the purpose of offering reference forperioperative ischemic stroke prevention related to anesthesia management.Methods:A total of 883 in-patients who undergoing OPCABG in Shanxi medical university's first hospital from January 2000 to December 2016 were retrospectively recruited,Twenty-two perioperative ischemic stroke patients served as an ischemic stroke group and eighty-eight patients who did not have perioperative ischemic stroke served as a control group in this study.Their clinical data were analyzed by Conditional Logistic regression analysis.Results:Stroke occurred in twenty-two patients(2.5%).The body mass index and partial pressure of carbon dioxide in artery were significantly higher while the incidence of hypertension,stroke history,intraoperative hypotension,intraoperative acidosis and carotid artery stenosis were significantly higher in ischemic stroke group than in control group[(24.6±1.9)Kg/m~2vs(23.5±2.3)Kg/m~2,P=0.047;(46.8±3.7)mmHgvs(40.2±2.9)mmHg,P=0.000;72.7%vs42.0%,P=0.028;81.8%vs27.3%,P=0.000;59.1%vs12.5%,P=0.000;40.9%vs1.1%,P=0.000;90.9%vs31.8%,P=0.000].Conditional Logistic stepwise regression analysis showed that stroke history,intraoperative hypotension and carotid artery stenosis were independent risk factors for perioperative ischemic stroke(OR=5.413,95%CI:1.825~16.057,P=0.002;OR=3.399,95%CI:1.452~7.957,P=0.005;OR=2.949,95%CI:1.643~5.292,P=0.000).Conclusion:Patients with stroke history or carotid artery stenosis deserve carefully perioperative anesthesia management and stable hemodynamics when perform OPCABG,which has a significant meaning to reduce the occurrence of perioperative ischemic stroke.