颈动脉内膜剥脱术治疗颈动脉狭窄的安全性及术后并发症的相关研究

发布时间：2018-05-14 14:28

本文选题：颈动脉内膜剥脱(CEA) + 颈动脉支架成形术(CAS)　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景脑卒中是老年人最常见的血管病之一,随着人类逐渐步入老龄化社会,脑卒中已经成为排名第二位严重影响人类生命安全及健康的疾病,其中颈动脉狭窄(Carotid artery stenosis)是缺血性脑卒中发生的常见病因。1953年DeBakey报道成功实现世界首例颈动脉内膜剥脱(CEA)手术,在这之后CEA凭借其优势逐渐被广人医学界人士和患者所接受,迅速成为世界范围内颈动脉狭窄的主要治疗策略。近儿年,血管内介入手术逐渐兴起,由于其对患者本身伤害小,同时术后并发症相对较少的优点,大有取代颈动脉内膜剥脱术的趋势。为此国际大量专家学者完成了很多相关临床试验,比较CEA及颈动脉支架成形术(CAS)的优劣,多数结果证明CEA较CAS治疗效果更好,且术后并发症相对较少,但关于CEA手术安全性的争论却从未停止,由于我国CEA手术开展较晚,CEA手术治疗规范尤其是术后并发症的预防及处理等问题亟待解决。研究目的本研究对齐鲁医院神经外科2014年1月—2016年1月2年间的所有符合标准的接受CEA治疗的患者临床资料进行总结,进行统计分析,为临床CEA术后并发症预防及处理提供参考。研究方法回顾分析齐鲁医院神经外科病区2014年1月—2016年1月2年间的所有进行CEA手术的患者,详细记录包括性别、年龄、吸烟状况、饮酒状况、合并症、首发症状、单(双)侧狭窄、狭窄程度、斑块性质、是否转流、术中血压、术后并发症及相关处理措施等信息。应用单因素和Logistic回归分析研究围术期处理同术后并发症发生的关系,总结CEA术后导致相关并发症发生的可能原因,进一步明确相应的预防及处理措施,从而提高CEA的安全性及有效性。研究结果1、本研究共纳入102例CEA病例,其中双侧狭窄49人,单侧狭窄53人,男性81人,女性21人,年龄42-82岁,平均年龄63.28±6.754。2、首发症状:无首发症状者5人,有症状者97人。其中短暂脑缺血发作(TIA)47人,缺血性卒中50人。肢体定位障碍40人,语言障碍12人,头晕29人,视力障碍18人。3、术前:有吸烟史43人,饮酒史31人,高血压病史68人,DM病史32人,冠心病病史16人,脑梗塞病史26人。4、术中:选择性转流31人,无人应用补片,全部采用连续缝合,全身麻醉,采用标准CEA术式,术毕术腔常规放置引流管一根。5、术后30天内并发症:缺血性卒中6人(5.9%),颅神经损伤9人(8.8%)。其中舌下神经受损3人(2.9%),迷走神经受损5人(4.9%),面神经下颌支受损1人(1.0%),脑高灌注综合征6人(5.9%),急性心肌梗死9人(8.8%),刀口血肿4人(3.9%),死亡2人(2.0%)。研究结论1、颈动脉狭窄程度是CEA术后卒中或死亡发生的危险因素。2、责任侧颈动脉狭窄程度与CEA术后出现颅脑高灌注损伤相关,为其危险因素。3、年龄和冠心病史为CEA术后急性心梗发生的独立相关因素,而性别为术后急性心梗发生的非独立危险因素。
[Abstract]:Background Stroke is one of the most common vascular diseases in the elderly. As people step into an aging society, stroke has become the second most serious disease affecting the safety and health of human life. Among them, carotid artery stenosisis is a common cause of ischemic stroke. In 1953, DeBakey reported that the world's first carotid endarterectomy was successfully performed. Since then, CEA has gradually been accepted by many people and patients because of its advantages. It has rapidly become the main treatment strategy for carotid artery stenosis worldwide. In recent years, endovascular interventional surgery has gradually emerged. Because of its advantages of less injury to patients and less postoperative complications, endarterectomy has a tendency to replace carotid endarterectomy. For this reason, a large number of international experts and scholars have completed a lot of related clinical trials to compare the advantages and disadvantages of CEA and carotid stenting. Most of the results show that CEA is more effective than CAS, and the postoperative complications are relatively few. However, the debate on the safety of CEA surgery has never stopped. Because of the late development of CEA surgery in our country, especially the prevention and treatment of postoperative complications, the problems need to be solved urgently. Objective to summarize and analyze the clinical data of all patients receiving CEA from January 2014 to January 2016 in Qilu Hospital. To provide a reference for the prevention and management of complications after CEA. Methods all the patients undergoing CEA operation from January 2014 to January 2016 in Qilu Hospital were retrospectively analyzed. The data included gender, age, smoking status, alcohol consumption, complications, initial symptoms, and other symptoms. Information on unilateral (bilateral) stenosis, degree of stenosis, plaque nature, bypass, intraoperative blood pressure, postoperative complications and related management. Univariate and Logistic regression analysis were used to study the relationship between perioperative management and postoperative complications, to summarize the possible causes of related complications after CEA, and to further clarify the corresponding prevention and treatment measures. In order to improve the security and effectiveness of CEA. Results 1. 102 cases of CEA were included in this study, including 49 cases of bilateral stenosis, 53 cases of unilateral stenosis, 81 males and 21 females, aged 42-82 years, with an average age of 63.28 卤6.754.2. The initial symptoms were as follows: 5 cases without initial symptoms and 97 cases with symptoms. Among them, there were 47 patients with transient ischemic attack and 50 with ischemic stroke. There were 40 patients with limb positioning disorder, 12 with speech disorder, 29 with dizziness, 18 with visual impairment. Preoperative smoking history was 43, drinking history was 31, hypertension history was 68, diabetes mellitus was 32, coronary heart disease history was 16. The history of cerebral infarction was 26. 4. During the operation, selective bypass was performed in 31 patients. No patch was used. All patients were treated with continuous suture, general anesthesia and standard CEA procedure. At the end of the operation, one drainage canal was placed in the cavities. The complications within 30 days after operation were as follows: 6 patients with ischemic stroke and 5.9patients with cranial nerve injury, and 9 patients with cranial nerve injury. Among them, 3 had hypoglossal nerve injury, 5 had vagus nerve injury, 1 had facial nerve mandibular branch injury, 6 had cerebral hyperperfusion syndrome, 9 had acute myocardial infarction, 4 had hematoma at the knife, and 2 died. Conclusions 1 the degree of carotid artery stenosis is the risk factor of stroke or death after CEA. The degree of responsible carotid artery stenosis is associated with craniocerebral hyperperfusion injury after CEA. Age and history of coronary heart disease were independent risk factors of acute myocardial infarction after CEA, and sex was independent risk factor of acute myocardial infarction after CEA.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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