2022 年第 2 期 第 17 卷

颈动脉狭窄患者经冠状动脉旁路移植术治疗后脑血流动力学变化与预后的关系

The relationship between changes of cerebral hemodynamics and prognosis in patients with carotid artery stenosis after coronary artery bypass grafting

作者：胡畅1李雷1王迁1刘思博1徐广阳1崔永亮2薛辉3

英文作者：Hu Chang1 Li Lei1 Wang Qian1 Liu Sibo1 Xu Guangyang1 Cui Yongliang2 Xue Hui3

单位：1清华大学第一附属医院血管外科，北京100016；2清华大学第一附属医院心脏内科，北京100016；3清华大学第一附属医院心脏外科，北京100016

英文单位：1Department of Vascular Surgery The First Hospital of Tsinghua University Beijing 100016 China; 2Department of Cardiology The First Hospital of Tsinghua University Beijing 100016 China; 3Department of Cardiac Surgery The First Hospital of Tsinghua University Beijing 100016 China

关键词：颈动脉狭窄；冠状动脉旁路移植术；脑血流动力学

英文关键词：Carotidarterystenosis;Coronaryarterybypassgrafting;Cerebralhemodynamics

• 摘要：

• 目的  探讨颈动脉狭窄患者经冠状动脉旁路移植术（CABG）治疗后脑血流动力学变化与预后的关系，为患者远期预后判断提供科学依据。方法  选择2015年8月到2020年6月清华大学第一附属医院收治的193例轻中度颈动脉狭窄患者为研究对象。按照是否采用CABG治疗分为观察组（124例）和对照组（69例）。观察组行CABG治疗，对照组行经皮冠状动脉介入治疗。记录比较2组颈内动脉狭窄管径、收缩期峰值流速（PSV）、阻力指数，患侧大脑中动脉（MCA）PSV、搏动指数及脑血管反应性（CVR）；根据日常生活活动能力量表（ADL）评分评价机体预后状况。结果  观察组术后1、3和12个月MCA-PSV明显大于对照组；术后12个月颈内动脉狭窄直径大于对照组，差异均有统计学意义（均P＜0.05）。2组患者在术后1、3、6和12个月的ADL评分均低于术前，且观察组低于对照组，差异均有统计学意义（均P＜0.05）。观察组患者在术后1、3、6和12个月各阶段CVR与ADL评分的相关性良好（|r|＞0.6，均P<0.05）。绘制术后脑血流动力学变化与预后关系的受试者工作特征曲线，拟合结果显示，术后脑血流动力学变化的曲线下面积为0.852（95%置信区间：0.777～0.929，P＜0.05），敏感度为79.5%，特异度为86.6%，最佳截断值为0.661，模型预测效果良好。CVR的变化与ADL评分为线性相关关系，即CVR的变化越大，ADL评分越低，二者呈反向变化趋势。结论  颈动脉狭窄患者经CABG术后脑血流动力学变化越大，血流通畅度越高，预后条件越好。

• Objective To explore the relationship between the changes of cerebral hemodynamics and prognosis in patients with carotid artery stenosis after coronary artery bypass grafting(CABG) treatment, and to provide scientific basis for judging the long-term prognosis of patients. Methods Totally 193 patients with mild to moderate carotid artery stenosis admitted to The First Hospital of Tsinghua University from August 2015 to June 2020 were selected. According to whether CABG treatment was used or not, they were divided into observation group(124 cases) and control group(69 cases). The observation group was treated with CABG, and the control group was treated with percutaneous coronary intervention. The diameter, peak systolic velocity(PSV) and resistance index of stenosal internal carotid artery, as well as PSV, pulsatility index and cerebrovascular reactivity(CVR) of the affected middle cerebral artery(MCA) were recorded and compared between the two groups. The prognosis was evaluated according to the activity of daily living (ADL) scale. Results The MCA-PSV in the observation group was significantly higher than that in the control group 1, 3 and 12 months after operation; the diameter of internal carotid artery stenosis in the observation group was greater than that in the control group 12 months after operation (all P<0.05). The ADL scores of the two groups 1, 3, 6 and 12 months after operation were lower than those before operation, and those in the observation group were lower than those in the control group(all P<0.05). The correlation between CVR and ADL score was good in the observation group 1, 3, 6 and 12 months after operation(|r|>0.6, all P<0.05). The receiver operating characteristic curve of the relationship between postoperative cerebral hemodynamic changes and prognosis was drawn. The fitting Results  showed that the area under the curve of postoperative cerebral hemodynamic changes was 0.852(95% confidence interval: 0.777-0.929, P<0.05), the sensitivity was 79.5%, the specificity was 86.6%, and the best cut-off value was 0.661; the prediction effect of the model was good. There was a linear correlation between the change of CVR and ADL score, the greater the change of CVR, the lower the ADL score, and the two show a reverse trend. Conclusion The greater the change of cerebral hemodynamics, the higher the patency of blood flow and the better the prognosis of patients with carotid artery stenosis after CABG.