本文選題：頸動脈狹窄　切入點：頸動脈支架置入術　出處：《廣州中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:一、分析本中心接受頸動脈支架成形術(CAS)患者入院中醫(yī)證候的分布特點,為腦血管介入術患者中醫(yī)藥的切入提供一定的臨床依據(jù)。二、分析評價我院腦病中心應用CAS手術治療頸動脈狹窄患者的有效性、安全性和技術可行性。方法:本研究收集我院腦病中心2010年1月至2015年12月期間行DSA明確頸動脈狹窄并擇期行CAS治療的患者,回顧性分析其基線資料、入院中醫(yī)證候、病變血管特點、圍手術期30天并發(fā)癥、術后長期隨訪的缺血性事件再發(fā)率和支架內(nèi)狹窄的情況。結果:一、本研究回顧性分析行CAS治療的121側的病變血管,技術成功率100%,狹窄程度由術前的80%(范圍:50-99%)降至術后10%(范圍:0-30%)。圍手術期30天卒中及死亡發(fā)生率為5.8%(7/121),全部為缺血性卒中,圍手術期間無死亡和腦出血發(fā)生。統(tǒng)計學分析顯示術中EPD使用在圍手術期30天缺血性卒中的發(fā)病情況中分布存在差異,且差異具有統(tǒng)計學意義(P0.01),而性別、年齡分層、狹窄的臨床分型、病變特點在圍手術期30天缺血性卒中的發(fā)病情況中分布差異均無統(tǒng)計學意義(P0.05)。臨床隨訪27月(范圍:3-83月)中,無術側相關缺血性事件發(fā)生;影像學隨訪的22.5月(范圍:3-83月)中,5例(5.8%)出現(xiàn)再狹窄,在65歲、糖尿病、癥狀性、極重度狹窄及殘余狹窄20%的患者中更趨于發(fā)生再狹窄,但是由于樣本量太少未行進一步統(tǒng)計學分析。二、在117例患者入院證型中,以"風痰瘀血,痹阻脈絡,"、"氣虛痰瘀阻絡"、"風痰上擾夾瘀"三種為主,在頸動脈狹窄臨床分型中,中醫(yī)入院證型分布差異具有統(tǒng)計學意義(P0.01),"風痰瘀血,痹阻脈絡"證型在癥狀性狹窄中構成比最高,達到56.6%,而無癥狀性狹窄中,"風痰上擾夾瘀"構成比較高,占34.1%。結論:一、本研究結果表明,CAS治療頸動脈狹窄是安全的、可行的和有效的,長期隨訪顯示術側相關缺血事件及支架內(nèi)再狹窄的發(fā)生率低;EPD的使用可能降低了圍手術期30天的缺血性事件的發(fā)生率。二、頸動脈狹窄患者的入院證型以"風痰瘀血,痹阻脈絡"、"氣虛痰瘀阻絡"、"風痰上擾夾瘀"三種為主,"風痰瘀血,痹阻脈絡"常見于癥狀性狹窄中,而"風痰上擾夾瘀"則在無癥狀性狹窄中更常見。
[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.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743

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