颈动脉内膜剥脱术治疗颈动脉狭窄的规范性的研究

发布时间：2018-04-28 17:11

本文选题：颈动脉内膜剥脱术 + 手术时机　；参考：《新疆医科大学》2014年硕士论文

【摘要】：目的：探讨颈动脉内膜剥脱术(carotid endarterectomy, CEA)治疗颈动脉狭窄上几个有争议的方面的规范性问题。方法：收集新疆医科大学第四附属医院进行的CEA手术63例的临床资料,进行回顾性分析。分别以手术时机、麻醉方式、放置转流、放置补片,这几个研究因素分成4个研究组。分别检验组间观察指标(主要为术后并发症,远期通畅率)是否有统计学差异。主要的观察指标与临床因素间使用Logistic回归分析,观察临床因素的危险度。结果：1、以表格形式描述各临床因素的初步统计结果和术后结果。2、分组研究。不同手术时机进行CEA手术的术后观察指标上无明显差异(P0.05)。早期手术并不比推迟手术风险高。不同麻醉方式下进行CEA手术的术后观察指标上无明显差异(P0.05)。两种麻醉方式都是安全的。是否放置转流进行CEA手术显示阻断时间、术后高灌注综合征存在显著差异(P0.05)。放置转流更加安全。是否放置补片在术后出现再狭窄上存在显著差异(P0.05)。放置补片减少术后再狭窄的发生。Logistic回归分析显示患侧狭窄度和术后血压波动是CEA术后脑卒中的危险因素(P0.05)；未放置转流、患侧狭窄度和术后血压波动是术后高灌注综合征的危险因素(P0.05)；未放置补片是远期再狭窄的危险因素(P0.05)。结论：CEA手术时机的把握上要严格评估病人病情,两种麻醉方式都是安全的,术中放置转流提高手术安全性,补片成形减少远期再狭窄。CEA手术治疗颈动脉狭窄尚待规范。
[Abstract]:Objective: to investigate several controversial normative issues in carotid artery stenosis treated by carotid endarterectomy (CEA). Methods: the clinical data of 63 cases of CEA operation in the fourth affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. These factors were divided into four study groups according to the time of operation, anaesthesia, transposition and patch placement. There were statistical differences in the observation indexes (mainly postoperative complications, long-term patency rate) between the two groups. The risk of clinical factors was observed by Logistic regression analysis. Results: 1. The preliminary statistical results and postoperative results of all clinical factors were described in tabular form. There was no significant difference in the postoperative indexes of CEA operation at different time of operation (P 0.05). Early surgery is no higher risk than delaying surgery. There was no significant difference in the postoperative indexes of CEA operation under different anesthetic methods (P 0.05). Both methods of anesthesia are safe. There was a significant difference in postoperative hyperperfusion syndrome (HPS) between two groups (P 0.05). Placement of diversion is safer. There was significant difference in restenosis after operation with or without patch placement (P 0.05). Logistic regression analysis showed that the degree of stenosis and the fluctuation of blood pressure were the risk factors of stroke after CEA. The degree of stenosis of the affected side and the fluctuation of blood pressure after operation were the risk factors of postoperative hyperperfusion syndrome (P 0.05), while no patch placement was the risk factor of long term restenosis. Conclusion both anesthesia methods are safe to evaluate the patient's condition strictly in order to grasp the opportunity of the operation. The safety of operation should be improved by placement of bypass during operation and the reduction of long term restenosis by patch forming should be regulated in the treatment of carotid artery stenosis.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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