脑卒中患者心脏导管术后再发急性脑血管意外分析.doc

脑卒中患者心脏导管术后再发急性脑血管意外分析 张华 张茁 [摘要] 目的 探讨既往患有脑卒中的患者行心脏导管术（CC）后再发脑血管病的特点以及相关因素分析。 方法 对892例实施了CC术的既往患有脑卒中的患者进行回顾性分析，通过对患者的一般状况、心脏血管病变数量、分布、治疗情况以及出现再发脑卒中的情况和相关因素进行分析。 结果 术中和术后24 h内101例患者出现脑卒中，占11.32%，33例出现短暂脑缺血发作（TIA），64例发生了急性脑梗死(CI)，4例并发脑出血(CH)。Logistic 回归分析显示脑血管患者CC术后再次出现急性脑血管意外的危险因素包括：男性、饮酒，高脂血症、患有外周血管病、心脏血管病变的数量以及治疗方法有关。结论 脑血管患者CC术后再次出现急性脑卒中的危险因素包括：男性、饮酒，高脂血症、患有外周血管病、心脏血管病变的数量以及治疗方法。 [关键词] 心脏导管术；脑血管意外；并发症 ；卒中 Cerebral vascular accidents after cardiac catheterization in stroke patients ZHANG Hua, ZHANG Zhuo. Department of Neurology, An Zhen Hospital of Capital University of Medical Science, Beijing 100029, China [Abstract] Objective To investigate the characteristics and risk factors of cerebral vascular accidents(CVA) after cardiac catheterization (CC) in stroke patients. Methods The clinical data of 892 stroke patients received CC since Jan.2002 to Oct.2006, were analyzed retrospectively. Results During and within 24hours after the operations,101 patients suffered from CVA (11.32%). 33 patients suffered from transient ischemic attack (TIA),64 patients suffered from cerebral infarction(CI) and 4patients suffered from cerebral hemorrhage(CH). Logistic regression models found that risk factors of CVA were associated with male gender(OR 0.308, 95%CI 0.141-0.674), alcohol(OR 0.319, 95%CI 0.128-0.797) , hyperlipidemia (OR 3.676, 95%CI 1.944-6.950), peripheral vascular diseases((OR 7.419, 95%CI 2.477-22.219),numbers of cardiac vascular diseases(OR 1.809, 95%CI 1.284-2.548). Patients under PTCA and stenting were much easier suffered from CVA compared to the other patients. Conclusions The risk factors after CC maybe male gender, alcohol, hyperlipidemia, peripheral vascular diseases, numbers of cardiac vascular diseases and PTCA and stenting. [Key words] Cardiac catheterization; Cerebral vascular accidents; Complication; Stroke 心脏导管术（cardiac catheterization, CC）目前已经成为一种常见的心脏病诊断和治疗方法。其中心血管造影（cardiac angiography，CA）为诊断心脏血管病的金指标，经皮腔内血管成型术（percutaneous transluminal coronary