颈动脉狭窄冠心病患者行冠状动脉旁路移植术的临床疗效分析OA

Objective To investigate the clinical efficacy of coronary artery bypass grafting(CABG)in patients with coronary heart disease(CHD)complicated by carotid artery stenosis under off-pump conditions.Methods A retrospective analysis was conducted on 125 patients who underwent CABG at The Second Hospital of Hebei Medical University from January 2020 to January 2024.Patients were divided into two groups:the carotid artery stenosis group(45 patients)and the non-stenosis group(80 patients),based on preoperative carotid artery stenosis status.The following clinical parameters were collected and statistically analyzed:operative duration,postoperative duration of mechanical ventilation,24-hour postoperative mediastinal drainage volume,length of postoperative hospital stay,incidence of arrhythmia,postoperative delirium,poor wound healing,intraoperative use of intra-aortic balloon pump,postoperative stroke,postoperative myocardial infarction,15-item Quality of Recovery(QoR-15)score at day 5 post-surgery,graft patency rate at 1 year post-surgery,and neurological function.Results No significant differences were observed in baseline characteristics or intraoperative parameters between the two groups(P>0.05).Compared with the non-stenosis group,the carotid artery stenosis group exhibited a significantly higher incidence of postoperative delirium(28.9ﾣ vs.6.3ﾣ),a lower median QoR-15 score on postoperative day 5(122.5 vs.126.0),and a prolonged median hospital stay(8.0 d vs.7.8 d)(χ2/U=7.357,-3.388,-2.073,respectively;all P<0.05).At the 1-year follow-up,the carotid artery stenosis group demonstrated a significantly elevated stroke incidence and a higher proportion of patients with increased modified Rankin Scale(mRS)scores(χ2=5.418,4.538,respectively;P<0.05).Conclusion Compared to patients with CHD alone,those with concurrent carotid artery stenosis who undergo CABG have a higher incidence of postoperative delirium,a longer hospital stay,a slower recovery process,and a poorer overall neurological functional status one-year postoperatively.