论文部分内容阅读
目的探讨应用颈动脉内膜切除术(CEA)治疗颈动脉狭窄患者的有效性和安全性,评估影响术后围手术期卒中和死亡的相关因素。方法回顾性分析2000年1月———2011年9月首都医科大学宣武医院采用CEA治疗的颈动脉狭窄患者的临床资料,共302例(对其中6例分期行双侧手术,每例按2例单独病例进行统计,共计308例)。分析手术的安全性、有效性,采用单因素及多因素Logistic回归分析,分析影响术后30 d内卒中和死亡的相关因素。结果①308例中,255例单纯狭窄的病例手术获得全部成功,53例完全闭塞或近全闭塞的患者中,5例血管再通失败。手术成功率为98.4%。②术后30 d内,卒中和死亡的患者有14例(4.5%),其中,死亡4例(1.3%),脑梗死7例(2.3%),脑出血3例(1.0%);脑神经损伤的有10例(3.3%),心肌梗死2例(0.6%),心绞痛2例(0.6%),心力衰竭2例(0.6%),心律失常8例(2.6%),术后出现暂时性的精神症状的有20例(6.5%)。③299例获≥1个月的随访,平均25.7个月。11例(3.7%)发生再狭窄,其中10例(3.3%)发生时间为1年左右。有2例(0.7%)术后出现短暂性脑缺血(TIA)症状,均为再狭窄的患者。④单因素分析结果显示,术后改良Rankin评分(mRS)≥3分者术后30d内卒中和死亡的发生率明显增高(P<0.05);多因素Logistic回归分析显示,吸烟(OR=0.198,95%CI:1.237～14.676)及mRS评分≥3分者(OR=11.707,95%CI:3.101～44.193)是导致术后30 d内卒中和死亡的独立影响因素。结论 CEA能有效地防治颈动脉狭窄导致的卒中发作风险。吸烟和术前mRS评分≥3可以增加CEA的危险性。
Objective To investigate the effectiveness and safety of carotid endarterectomy (CEA) in the treatment of patients with carotid artery stenosis and to evaluate the related factors influencing perioperative stroke and death after operation. Methods The clinical data of 302 patients with carotid artery stenosis treated with CEA at Xuanwu Hospital, Capital Medical University from January 2000 to September 2011 were retrospectively analyzed. Six patients underwent bilateral surgery in each of them Cases of separate cases statistics, a total of 308 cases). The safety and effectiveness of the operation were analyzed. The single factor and multivariate Logistic regression analysis were used to analyze the related factors that affected the stroke and death within 30 days after operation. Results ① Of the 308 cases, 255 cases of simple stenosis were completely successful. Of the 53 patients with complete or nearly complete occlusion, 5 failed to recanalization. The success rate of surgery was 98.4%. In the 30 days after operation, there were 14 cases (4.5%) of stroke and death, including 4 deaths (1.3%), 7 cerebral infarctions (2.3%) and 3 cerebral hemorrhage There were 10 cases (3.3%) of injury, 2 cases of myocardial infarction (0.6%), 2 cases of angina (0.6%), 2 cases of heart failure (0.6%) and 8 cases of arrhythmia (2.6% There are 20 cases of psychiatric symptoms (6.5%). ③ 299 cases were ≥ 1 month follow-up, an average of 25.7 months. Restenosis occurred in 11 patients (3.7%), of which 10 (3.3%) occurred for about 1 year. Two patients (0.7%) had transient ischemic (TIA) symptoms after surgery, all of whom were patients with restenosis. The results of univariate analysis showed that the incidence of stroke and death within 30 days after modified Rankin score (mRS) ≥3 was significantly higher (P <0.05). Multivariate Logistic regression analysis showed that smoking (OR = 0.198, 95% CI: 1.237-14.676) and mRS score ≥3 (OR = 11.707,95% CI: 3.101-44.193) were the independent factors leading to stroke and death within 30 days after operation. Conclusions CEA can effectively prevent and treat the risk of stroke caused by carotid stenosis. Smoking and preoperative mRS score ≥ 3 may increase the risk of CEA.