颈动脉支架成形术患者中医证候及疗效分析

发布时间：2018-03-09 06:19

本文选题：颈动脉狭窄　切入点：颈动脉支架置入术　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:一、分析本中心接受颈动脉支架成形术(CAS)患者入院中医证候的分布特点,为脑血管介入术患者中医药的切入提供一定的临床依据。二、分析评价我院脑病中心应用CAS手术治疗颈动脉狭窄患者的有效性、安全性和技术可行性。方法:本研究收集我院脑病中心2010年1月至2015年12月期间行DSA明确颈动脉狭窄并择期行CAS治疗的患者,回顾性分析其基线资料、入院中医证候、病变血管特点、围手术期30天并发症、术后长期随访的缺血性事件再发率和支架内狭窄的情况。结果:一、本研究回顾性分析行CAS治疗的121侧的病变血管,技术成功率100%,狭窄程度由术前的80%(范围:50-99%)降至术后10%(范围:0-30%)。围手术期30天卒中及死亡发生率为5.8%(7/121),全部为缺血性卒中,围手术期间无死亡和脑出血发生。统计学分析显示术中EPD使用在围手术期30天缺血性卒中的发病情况中分布存在差异,且差异具有统计学意义(P0.01),而性别、年龄分层、狭窄的临床分型、病变特点在围手术期30天缺血性卒中的发病情况中分布差异均无统计学意义(P0.05)。临床随访27月(范围:3-83月)中,无术侧相关缺血性事件发生;影像学随访的22.5月(范围:3-83月)中,5例(5.8%)出现再狭窄,在65岁、糖尿病、症状性、极重度狭窄及残余狭窄20%的患者中更趋于发生再狭窄,但是由于样本量太少未行进一步统计学分析。二、在117例患者入院证型中,以"风痰瘀血,痹阻脉络,"、"气虚痰瘀阻络"、"风痰上扰夹瘀"三种为主,在颈动脉狭窄临床分型中,中医入院证型分布差异具有统计学意义(P0.01),"风痰瘀血,痹阻脉络"证型在症状性狭窄中构成比最高,达到56.6%,而无症状性狭窄中,"风痰上扰夹瘀"构成比较高,占34.1%。结论:一、本研究结果表明,CAS治疗颈动脉狭窄是安全的、可行的和有效的,长期随访显示术侧相关缺血事件及支架内再狭窄的发生率低;EPD的使用可能降低了围手术期30天的缺血性事件的发生率。二、颈动脉狭窄患者的入院证型以"风痰瘀血,痹阻脉络"、"气虚痰瘀阻络"、"风痰上扰夹瘀"三种为主,"风痰瘀血,痹阻脉络"常见于症状性狭窄中,而"风痰上扰夹瘀"则在无症状性狭窄中更常见。
[Abstract]:Objective: first, to analyze the characteristics of TCM syndrome distribution in patients undergoing carotid stenting in our center, and to provide a clinical basis for the entry of traditional Chinese medicine in patients undergoing cerebrovascular interventional surgery. To evaluate the effectiveness of CAS operation in the treatment of carotid artery stenosis in patients with encephalopathy in our hospital. Methods: from January 2010 to December 2015, we collected the patients with carotid artery stenosis treated with DSA and treated with CAS from January 2010 to December 2015. The baseline data and TCM syndromes were analyzed retrospectively. Vascular characteristics, perioperative 30 days complications, recurrence rate of ischemic events and stent stenosis in long-term follow-up were analyzed retrospectively. The technical success rate was 100 and the degree of stenosis decreased from 80 to 10 after operation from 80 to 10. The incidence of stroke and death during the 30 days of perioperative period was 5.8 / 121, all of which were ischemic stroke. There was no death or intracerebral hemorrhage during perioperative period. Statistical analysis showed that there were differences in the distribution of intraoperative EPD in the incidence of ischemic stroke during perioperative period of 30 days, and the difference was statistically significant (P 0.01), but gender and age were stratified. There was no significant difference in the distribution of the clinical types of stenosis and pathological changes in the incidence of ischemic stroke during perioperative period of 30 days (P 0.05). During the follow-up period of 27 months (range: 3-83 months), no related ischemic events occurred. Restenosis occurred in 5 patients (range: 3.83 months) in 22.5 months (range: 3-83 months) with restenosis in 65 years of age, diabetes mellitus, symptomatic, extremely severe stenosis and residual stenosis in 20% patients. However, because the sample size is too small, no further statistical analysis has been carried out. Second, among the 117 admission card types, the three main types are "wind phlegm and blood stasis, arthralgia and choroid obstruction," "qi deficiency and phlegm stasis obstruction of collaterals", and "wind and phlegm disturbance and clamping stasis", which are mainly in the clinical classification of carotid artery stenosis. The difference in the distribution of TCM admission card was statistically significant (P 0.01). "Wind phlegm blood stasis, obstruction of choroid" syndrome had the highest constituent ratio in symptomatic stenosis, reaching 56.6, while in asymptomatic stenosis, "wind and phlegm disturbance and blood stasis" was relatively high, accounting for 34.1.Conclusion: 1. The results of this study indicate that CAS is safe, feasible and effective in the treatment of carotid artery stenosis. Long-term follow-up showed that the incidence of surgical side related ischemic events and stent restenosis was low. The use of EPD may reduce the incidence of ischemic events in the perioperative period of 30 days. Second, the admission card type of carotid artery stenosis was "wind phlegm stasis blood," There are three main types of collateral obstruction, namely "qi deficiency and phlegm stasis", "wind phlegm and blood stasis", "wind phlegm blood stasis" and "obstruction of veins" in symptomatic stenosis, while "wind phlegm and phlegm disturbing and clamping stasis" is more common in asymptomatic stenosis.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

【参考文献】