目的 分析颈动脉内膜切除术(carotid endarterectomy,CEA)在围术期的安全性。方法 回顾性分析2014-01至2017-11我院脑血管外科收治的128例颈动脉狭窄行颈动脉内膜切除术的患者的临床资料。结果 围术期(术后30 d内)死亡和脑卒中发生率为4.4%。年龄≥70岁组与<70岁组(4.9%比4.3%)、女性组与男性组(5.6%比4.0%)、高血压组与非高血压组(3.2%比7.5%)、糖尿病组与非糖尿病组(7.0%比3.3%)、单侧颈动脉狭窄组与双侧颈动脉狭窄组(5.4%比2.4%)、吸烟史组与无吸烟史组(1.7%比6.7%)、症状组与无症状组(5.3%比0)、左侧手术组与右侧手术组(7.2%比1.5%)患者围术期死亡和卒中的发生率差异均无统计学意义(均P>0.05)。结论 颈动脉内膜切除术是一种治疗颈动脉狭窄的安全的干预措施。在规范的内科治疗、注重手术过程中的操作细节和严格的术后管理的前提下,患者年龄≥70岁、女性、合并高血压、糖尿病、合并对侧颈动脉狭窄(>50%)、吸烟史、症状性颈动脉狭窄、左侧手术等因素都不会显著增加CEA围术期发生死亡或卒中风险。
Abstract
Objective To analyze the perioperative safety of carotid endarterectomy (CEA).Methods The clinical records of 128 patients with carotid artery stenosis treated with carotid endarterectomy between January 2014 and November 2017 were retrospectively reviewed.Results Within this cohort,the rate of perioperative stroke and death was 4.4%.There was no significant difference in the rates of perioperative stroke and death between patients above 70 and those under 70 (4.9% vs 4.3%),between female and male patients(5.6% vs 4.0%),between hypertension and non-hypertension patients(3.2% vs 7.5%),between diabetes and non-diabetes patients(7.0% vs 3.3%),between unilateral and bilateral patients(5.4% vs 2.4%),between smokers and non-smokers(1.7% vs 6.7%),between symptomatic and asymptomatic patients(5.3% vs 0) or between recipients of surgery on the left and those on the right side(7.2% vs 1.5%) (all P>0.05).Conclusions Carotid endarterectomy is safe for the treatment of carotid stenosis. As long as standardized medical treatment, emphasis on details of surgery and strict postoperative management are in place, age above 70, femininity, hypertension, diabetes, coronary heart disease, complications with contralateral carotid artery stenosis (>50%), smoking, symptomatic carotid artery stenosis, surgery on the left side do not increase the risk of CEA perioperatively.
关键词
颈动脉内膜切除术 /
回顾性研究 /
围术期 /
安全性
Key words
carotid endarterectomy /
retrospective study /
perioperative period /
safety
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参考文献
[1] 孙海欣,王文志.中国脑卒中患病率、发病率和死亡率调查结果发表[J].中华神经科杂志,2017,50(5):337.
[2] North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis[J]. Nengl J Med, 1991, 325(7): 445-453.
[3] Halliday A, Harrison M, Hayter E, et al. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial[J]. The Lancet, 2010,376(9746):1074-1084.
[4] Kernan W N, Ovbiagele B, Black H R, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2014, 45(7): 2160-2236.
[5] Meschia J F, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American heart association/American stroke association[J]. Stroke, 2014, 45(12): 3754-3832.
[6] 翟卫东,钟建卫,王 涛,等.高血压脑出血并发大面积脑梗死的危险因素分析[J].武警医学,2014,25(5):497-499.
[7] 叶 炜,宋小军,刘昌伟,等.颈动脉内膜切除术与围手术期高血压[J].血管与腔内血管外科杂志,2016,2(5):435-439.
[8] 刘昌伟,倪 冷,陈跃鑫,等.颈动脉内膜切除术618例经验总结及结果分析[J].中华医学杂志,2015,95(24):1897-1901.
[9] 余 翀,李毅清.颈动脉内膜切除术的预后及其危险因素的研究[J].血管与腔内血管外科杂志,2016,2(4):293-310.
[10] 赵克强,吴巍巍,赵俊来,等.颈动脉狭窄合并糖尿病患者行颈动脉内膜剥脱术的疗效分析[J].中华医学杂志,2015,95(44):3584-3587.
[11] Ricotta J J, AbuRahma A, Ascher E, et al. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease[J]. Journal of vascular surgery, 2011, 54(3): 1-31.
[12] Guzman R P, Weighell W, Guzman C, et al. Female sex does not influence 30-day stroke and mortality rates after carotid endarterectomy[J]. Annals of vascular surgery, 2014, 28(1): 245-252.
[13] Stoberock K, Debus ES, Atlihan G, et al. Gender differences in patients with carotid stenosis[J]. Vasa, 2016, 45(1): 11-6.
[14] Halm E A, Tuhrim S, Wang J J, et al. Risk factors for perioperative death and stroke after carotid endarterectomy[J]. Stroke, 2009, 40(1): 221-229.
[15] Mantese V A, Timaran C H, Chiu D, et al. The carotid revascularization endarterectomy versus stenting trial (CREST)[J]. Stroke, 2010, 41(10): S31-S34.
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