Strategy for the reduction of stroke incidence in cardiac surgical patients.
Strategy for the reduction of stroke incidence in cardiac surgical patients.
复制标题
降低心脏手术患者中风发生率的策略。
DOI：
10.1016/0003-4975(93)91079-3
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Kouchoukos,NT
中科院分区：
文献类型：
--
作者：
Wareing,TH;Davila-Roman,VG;Daily,BB;Murphy,SF;Schechtman,KB;Barzilai,B;Kouchoukos,NT
升主动脉粥样硬化（AAA）和严重的颈动脉疾病是心脏手术患者发生卒中的危险因素。在1,334例50岁或以上心脏手术患者的连续系列中，通过术中超声扫描筛选1200例AAA，并通过颈动脉多普勒扫描筛选颈动脉闭塞性疾病（791/798例≥65岁和更年轻的症状性患者）。88%的患者存在冠状动脉疾病。中度或重度AAA患者（n = 231;占总数的19.3%）通过升主动脉置换术（n = 27）或改良的、不太广泛的技术（n = 168）进行治疗，以避开动脉粥样硬化区域。33例行颈动脉内膜剥脱术和心脏手术。1,200名患者的30天死亡率和卒中率分别为4.0%和1.6%。在969例无或轻度AAA患者中，卒中发生率较低（1.1%）。27例中重度AAA患者行升主动脉置换术，33例颈动脉内膜切除术，均为0。111例中度或重度升主动脉疾病患者仅接受轻微干预（6.3%），16例重度颈动脉疾病患者未接受颈动脉内膜切除术（18.7%），卒中发生率较高。对AAA和颈动脉疾病进行筛查，并对中度或重度AAA和重度或症状性颈动脉疾病进行积极的手术治疗，似乎可以降低老年心脏手术患者的卒中频率。
Atherosclerosis of the ascending aorta (AAA) and severe carotid artery disease are risk factors for stroke in cardiac surgical patients. Twelve hundred of a consecutive series of 1,334 patients 50 years of age or older having a cardiac operation were screened for the presence of AAA by intraoperative ultrasonographic scanning and for the presence of carotid artery occlusive disease (791 of 798 patients ≥65 years of age and younger symptomatic patients) by carotid duplex scanning. Coronary artery disease was present in 88% of the patients. Patients with moderate or severe AAA (n = 231; 19.3% of the total) were treated by ascending aortic replacement (n = 27) or by modified, less extensive techniques (n = 168) to avoid the atherosclerotic areas. Thirty-three patients had combined carotid endarterectomy and cardiac operation. Thirty-day mortality and stroke rates for the 1,200 patients were 4.0% and 1.6%, respectively. The stroke rate was low (1.1%) among the 969 patients with no or mild AAA. It was zero among 27 patients with moderate or severe AAA who had ascending aortic replacement and among the 33 patients who had carotid endarterectomy. The stroke rates were higher for 111 patients with moderate or severe ascending aortic disease who had only minor interventions (6.3%) and for 16 patients with severe carotid artery disease who did not have carotid endarterectomy (18.7%). Screening for AAA and carotid artery disease and aggressive surgical treatment of moderate or severe AAA and severe or symptomatic carotid artery disease appears to reduce the frequency of stroke in older cardiac surgical patients.
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DOI：
10.1172/jci110931
发表时间：
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期刊：
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