發(fā)布時(shí)間：2018-05-14 14:28

  本文選題：頸動(dòng)脈內(nèi)膜剝脫(CEA) + 頸動(dòng)脈支架成形術(shù)(CAS)　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景腦卒中是老年人最常見的血管病之一,隨著人類逐漸步入老齡化社會(huì),腦卒中已經(jīng)成為排名第二位嚴(yán)重影響人類生命安全及健康的疾病,其中頸動(dòng)脈狹窄(Carotid artery stenosis)是缺血性腦卒中發(fā)生的常見病因。1953年DeBakey報(bào)道成功實(shí)現(xiàn)世界首例頸動(dòng)脈內(nèi)膜剝脫(CEA)手術(shù),在這之后CEA憑借其優(yōu)勢(shì)逐漸被廣人醫(yī)學(xué)界人士和患者所接受,迅速成為世界范圍內(nèi)頸動(dòng)脈狹窄的主要治療策略。近兒年,血管內(nèi)介入手術(shù)逐漸興起,由于其對(duì)患者本身傷害小,同時(shí)術(shù)后并發(fā)癥相對(duì)較少的優(yōu)點(diǎn),大有取代頸動(dòng)脈內(nèi)膜剝脫術(shù)的趨勢(shì)。為此國(guó)際大量專家學(xué)者完成了很多相關(guān)臨床試驗(yàn),比較CEA及頸動(dòng)脈支架成形術(shù)(CAS)的優(yōu)劣,多數(shù)結(jié)果證明CEA較CAS治療效果更好,且術(shù)后并發(fā)癥相對(duì)較少,但關(guān)于CEA手術(shù)安全性的爭(zhēng)論卻從未停止,由于我國(guó)CEA手術(shù)開展較晚,CEA手術(shù)治療規(guī)范尤其是術(shù)后并發(fā)癥的預(yù)防及處理等問(wèn)題亟待解決。研究目的本研究對(duì)齊魯醫(yī)院神經(jīng)外科2014年1月—2016年1月2年間的所有符合標(biāo)準(zhǔn)的接受CEA治療的患者臨床資料進(jìn)行總結(jié),進(jìn)行統(tǒng)計(jì)分析,為臨床CEA術(shù)后并發(fā)癥預(yù)防及處理提供參考。研究方法回顧分析齊魯醫(yī)院神經(jīng)外科病區(qū)2014年1月—2016年1月2年間的所有進(jìn)行CEA手術(shù)的患者,詳細(xì)記錄包括性別、年齡、吸煙狀況、飲酒狀況、合并癥、首發(fā)癥狀、單(雙)側(cè)狹窄、狹窄程度、斑塊性質(zhì)、是否轉(zhuǎn)流、術(shù)中血壓、術(shù)后并發(fā)癥及相關(guān)處理措施等信息。應(yīng)用單因素和Logistic回歸分析研究圍術(shù)期處理同術(shù)后并發(fā)癥發(fā)生的關(guān)系,總結(jié)CEA術(shù)后導(dǎo)致相關(guān)并發(fā)癥發(fā)生的可能原因,進(jìn)一步明確相應(yīng)的預(yù)防及處理措施,從而提高CEA的安全性及有效性。研究結(jié)果1、本研究共納入102例CEA病例,其中雙側(cè)狹窄49人,單側(cè)狹窄53人,男性81人,女性21人,年齡42-82歲,平均年齡63.28±6.754。2、首發(fā)癥狀:無(wú)首發(fā)癥狀者5人,有癥狀者97人。其中短暫腦缺血發(fā)作(TIA)47人,缺血性卒中50人。肢體定位障礙40人,語(yǔ)言障礙12人,頭暈29人,視力障礙18人。3、術(shù)前:有吸煙史43人,飲酒史31人,高血壓病史68人,DM病史32人,冠心病病史16人,腦梗塞病史26人。4、術(shù)中:選擇性轉(zhuǎn)流31人,無(wú)人應(yīng)用補(bǔ)片,全部采用連續(xù)縫合,全身麻醉,采用標(biāo)準(zhǔn)CEA術(shù)式,術(shù)畢術(shù)腔常規(guī)放置引流管一根。5、術(shù)后30天內(nèi)并發(fā)癥:缺血性卒中6人(5.9%),顱神經(jīng)損傷9人(8.8%)。其中舌下神經(jīng)受損3人(2.9%),迷走神經(jīng)受損5人(4.9%),面神經(jīng)下頜支受損1人(1.0%),腦高灌注綜合征6人(5.9%),急性心肌梗死9人(8.8%),刀口血腫4人(3.9%),死亡2人(2.0%)。研究結(jié)論1、頸動(dòng)脈狹窄程度是CEA術(shù)后卒中或死亡發(fā)生的危險(xiǎn)因素。2、責(zé)任側(cè)頸動(dòng)脈狹窄程度與CEA術(shù)后出現(xiàn)顱腦高灌注損傷相關(guān),為其危險(xiǎn)因素。3、年齡和冠心病史為CEA術(shù)后急性心梗發(fā)生的獨(dú)立相關(guān)因素,而性別為術(shù)后急性心梗發(fā)生的非獨(dú)立危險(xiǎn)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 鹵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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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本文編號(hào)：1888253