Influence of previous cerebral Infarction on postoperative recovery in patients undergoing cornary artery bypass grafting / 中华胸心血管外科杂志

ABSTRACT

Objective To study the postoperative recovery in patients undergoing coronary artery bypass grafting (CABG)with a history of cerebral infarction.Methods From January 2007 to December 2007,112 patients undergoing elective off-pump coronary artery bypass grafting(OPCABG)with a history of cerebral infarction were studied retrospectively.Each of the 112 patients was matched with 1 control patient who had no cerebral infarction history and were undergoing an elective OPCABG either immediately before or immediately after the study patient,in most cases by the same surgeons.Preoperative characteristics,anesthesia time,awakening time,extubation time,ICU stay,hospital stay,reintubation,hospital mortality,postoperative confusion and stroke were compared in the two groups.Results There were no significant differences between the study and control Patients in the most preoperative characteristics,only the incidence of hypertension and diabetes mellitus were higher than those in control group,P<0.05(78 of 112,69.6% versus 61 of 112,54.5%;52 of 112,46.4% versus 26 of 112,23.2%).The study group took longer to awaken,extubate and stay in ICU and hospital than the control group,P<0.01[(6.4±4.0)h versus(4.6±2.7)h,(19.6±9.7)h versus(16.8±5.5)h,(27.3±16.8)h versus(22.1±10.6)h,(23.4±10.0)d versus(19.5±5.6)]d.The incidence of confusion,stroke and reintubation after operation among the study group was higher than those in control group,P<0.05(17 of 112,15.2% versus 4 of 112,6.3%;8 of 112,7.1% versus 1 of 112,0.9%;8 of 112,7.1% versus 1 of 112,0.9%),RR and 95% CI were 4.83(1.57～14.86)、8.54(1.05～69.45)and 8.54(1.05～69.45).There were no significant differences between the study and control patients in the anesthesia time and hospital mortality.Stroke after the operations was found in 8 of 112 study patients and included cerebral infarction in 6 and transient ischemic attack(TIA)in 2.The 8 patients included new stroke in 7 and worsening of old stroke in 1 without new abnomalities on head computed tomography.1 of 8 patients had early stroke(≤24 hours after operation)and others had late stroke(>24 hours).Conclusion The patients with previous cerebral infarction undergoing off-pump coronary artery bypass grafting took longer to awaken,extubate,stay in ICU and hospital.These patients were more likely to have reintubation,confusion and stroke after operation than those patients with no cerebral infarction history.