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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
龚志云,任崇雷,姜胜利,王明岩,肖苍松,高长青*.CHADS2评分对心房颤动患者二尖瓣置换术围手术期脑卒中风险的预测作用[J].中华老年多器官疾病杂志,2016,15(10):744~748
CHADS2评分对心房颤动患者二尖瓣置换术围手术期脑卒中风险的预测作用
Predictive role of CHADS2 score for perioperative stroke risk in atrial fibrillation patients undergoing mitral valve replacement surgery
投稿时间:2016-06-07  
DOI:10.11915/j.issn.1671-5403.2016.10.177
中文关键词:  心房颤动;脑卒中;二尖瓣置换;CHADS2评分
英文关键词:atrial fibrillation; stroke; mitral valve replacement; CHADS2 score
基金项目:
作者单位E-mail
龚志云,任崇雷,姜胜利,王明岩,肖苍松,高长青* 解放军总医院心血管外科,解放军心脏外科研究所,北京 100853 gaochq301@yahoo.com 
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中文摘要:
      目的 缺血性脑卒中是心脏手术后严重并发症,但其危险因素尚待进一步研究。本研究旨在探讨CHADS2评分对二尖瓣置换术围手术期脑卒中风险的预测作用。方法 选择2005年1月至2014年12月解放军总医院心血管外科行二尖瓣置换且术前合并房颤的患者共805例,年龄(53.7±10.5)岁,女性422例(52.4%)。观察不同CHADS2评分患者二尖瓣置换术后住院期间缺血性脑卒中发生情况;比较CHADS2评分≥2组和评分<2组脑卒中发生率;采用多因素logistic回归分析方法对围手术期常见脑卒中危险因素进行分析,研究CHADS2评分与术后脑卒中的关系。结果 全组患者CHADS2评分为0分者493例(612%),1分者185例(230%),2分者92例(114%),3分者26例(32%),4分者9例(11%)。术后住院期间发生缺血性脑卒中共14例,发生率为17%。住院期间死亡16例,死亡率20%。脑卒中发生于CHADS2评分为0分者6例(发生率12%),1分者2例(发生率11%),2分者3例(发生率33%),3分者2例(发生率77%),4分者1例(发生率111%)。与CHADS2评分<2组比较,CHADS2评分≥2组脑卒中发生率显著升高(47% vs 12%;P=0005)。与低CHADS2评分组比较,高CHADS2评分组患者术前合并颈动脉狭窄、术中同期行CABG和植入机械瓣比例较高,术后机械通气时间更长(P<005)。两组患者术后ICU停留时间以及住院期间病死率差异均无统计学意义(P>005)。多因素logistic回归分析结果显示,CHADS2评分≥2(OR=4164, 95%CI:1388~12495; P=0011)和术后应用重组人凝血因子Ⅶa(OR=11757, 95%CI:2909~47520; P=0.001)是术后住院期间脑卒中的独立危险因素。结论 CHADS2评分高的房颤患者二尖瓣置换术后住院期间脑卒中发生率更高,CHADS2评分≥2是术后住院期间脑卒中的独立危险因素。CHADS2评分对于预测房颤患者二尖瓣置换术围手术期脑卒中风险有一定价值,值得进一步研究。
英文摘要:
      Objective Ischemic stroke is a severe complication following cardiac surgery, but its risk factors remain unclear and need further study. This study assessed the predictive value of CHADS2 scores for perioperative ischemic stroke among atrial fibrillation (AF) patients undergoing mitral valve replacement surgery. Methods A total of 805 AF patients, with females accounting for 524% and at a mean age of (53.7±10.5) years, undergoing mitral valve replacement in our hospital from January 2005 to December 2014 were recruited in this study. Their CHADS2 scores were used to stratify the risk for perioperative stroke. The incidence of stroke during hospitalization was observed and compared between those with the score ≥2 and the score<2. Multivariate logistic regression analysis was performed to determine the risk fcrtors used to predict stroke. The correlation of the score with perioperative stroke was analyzed. Results The CHADS2 scores were as follows in the subjects: 0 point in 493 cases (61.2%), 1 point in 185 cases (23.0%), 2 points in 92 cases (11.4%), 3 points in 26 cases (3.2%) and 4 points in 9 cases (1.1%). There were 14 patients (1.7%) having stroke and 16 (2.0%) dying during hospital stay. Stroke occurred in 6 cases in the 0-point patients (1.2%), 2 cases in the 1-point patients (1.1%), 3 cases in the 2-point patients (3.3%), 2 cases in the 3-point patients (77%), and 1 case in the 4-point patients (111%). Compared with the patients with CHADS2 score <2, those with the score ≥2 had higher incidence of stroke duringhospitalization (47% vs 12%, P=0005). The patients with higher CHADS2 score had higher proportions of being complicated with carotid artery stenosis, undergoing coronary artery bypass grafting (CABG) simultaneously, receiving mechanical valve replacement, and taking longer mechanical ventilation time post-operatively when compared with those with lower score (P<0.05). But there were no differences in the ICU stay length and intra-hospital mortality between them (P>0.05). Multivariate logistic regression analysis showed that the CHADS2 score ≥2 (OR=4.164, 95%CI: 1.388-12.495; P=0.011) and application of recombinant human coagulation factor Ⅶa (OR=11.757, 95%CI: 2.909-47.520; P=0.001) were independent risk factors for stroke during hospitalization. Conclusion There is an increased risk for stroke in the AF patients with higher CHADS2 score after mitral valve replacement. CHADS2 score ≥2 is an independent risk factor for stroke during hospitalization. The score is of significant value in the prediction of perioperative ischemic stroke in the AF patients undergoing mitral valve replacement surgery and worth further study.
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