【摘要】：目的:本研究旨在探討腦血管狹窄在行支架術(shù)時(shí),顱內(nèi)外血管存在風(fēng)險(xiǎn)的差異。通過(guò)觀察在圍手術(shù)期以及圍手術(shù)期后1年內(nèi)出現(xiàn)與支架相關(guān)的不良反應(yīng)以及并發(fā)癥情況,為臨床上預(yù)防和減少手術(shù)風(fēng)險(xiǎn)提供有益信息。方法:選取2009~2012年于滄州市中心醫(yī)院神經(jīng)內(nèi)科進(jìn)行腦血管支架置入治療的200例顱內(nèi)外血管狹窄患者為研究對(duì)象,分為頸內(nèi)動(dòng)脈狹窄組和頸動(dòng)脈顱內(nèi)段狹窄組2組,頸內(nèi)動(dòng)脈狹窄組100例,頸動(dòng)脈顱內(nèi)段狹窄組100例。支架置入點(diǎn)均為引起腦缺血事件的相關(guān)血管。對(duì)兩組患者技術(shù)操作、術(shù)后并發(fā)癥、術(shù)后1年隨訪資料分別進(jìn)行統(tǒng)計(jì)學(xué)分析處理。結(jié)果:1圍手術(shù)期內(nèi),頸內(nèi)動(dòng)脈狹窄組100例技術(shù)操作全部成功,術(shù)中并發(fā)癥15例,分別為(血壓和心率下降)迷走反射導(dǎo)致心率及血壓下降、(缺血性卒中)腦梗死、皮下血腫、假(性)層動(dòng)脈瘤、(一過(guò)性腦缺血)短暫性腦缺血發(fā)作等;頸動(dòng)脈顱內(nèi)段狹窄組100例技術(shù)操作中有97例成功,2例死亡,1例支架置入失敗后進(jìn)行經(jīng)皮血管腔內(nèi)血管成形術(shù),手術(shù)成功率為97%,死亡率為2%,術(shù)中并發(fā)癥17例,分別為缺血性卒中、動(dòng)脈夾層、血管痙攣、呼吸和心跳驟停等。2頸內(nèi)動(dòng)脈狹窄組經(jīng)支架置入治療后,其血管狹窄率由治療前的(75.68±7.32)%減小為(12.45±9.34)%;頸動(dòng)脈顱內(nèi)段狹窄組由治療前的(74.93±11.33)%減小為(26.78±13.44)%,兩者與術(shù)前比較狹窄程度均得到改善(P0.05)。3頸內(nèi)動(dòng)脈狹窄組患者術(shù)后1年隨訪,血管閉塞率為2%(2/100)例,新發(fā)腦梗死為3%(3/100),短暫性腦缺血率為14%(14/100),腦出血率為1%(1/100);頸動(dòng)脈顱內(nèi)段狹窄組術(shù)后1年隨訪,血管閉塞率為7.14%(7/98),新發(fā)腦梗死為18.37%(18/98),短暫性腦缺血率為29.59%(29/98),無(wú)腦出血事件發(fā)生。頸內(nèi)動(dòng)脈組血管閉塞率、新發(fā)腦梗死率、短暫性腦缺血率均顯著低于頸動(dòng)脈顱內(nèi)段狹窄組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),而2組的腦出血率差異不顯著(P0.05)。4所有入組患者術(shù)后1年支架段血管再狹窄率隨訪結(jié)果顯示,頸內(nèi)動(dòng)脈組輕度狹窄6例、中度狹窄3例、重度狹窄1例,再狹窄發(fā)生率為10%(10/100);頸動(dòng)脈顱內(nèi)段狹窄組輕度狹窄9例,中度狹窄10例,重度狹窄3例,再狹窄率為22.45%(22/98)。頸動(dòng)脈顱內(nèi)段狹窄組與頸內(nèi)動(dòng)脈組相比術(shù)后1年支架再狹窄率顯著增高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。5顱內(nèi)外血管狹窄危險(xiǎn)因素分析顯示,患者血清HCY水平與動(dòng)脈狹窄程度呈正比(P0.01);血清hr-CRP與動(dòng)脈狹窄程度呈正比(P0.05);血清HDL水平與動(dòng)脈狹窄程度呈負(fù)相關(guān)(P0.05);血清LDL水平與動(dòng)脈狹窄程度呈正比(P0.05)。Logistic回歸分析結(jié)果表明,糖尿病、高血壓是引起顱內(nèi)外血管狹窄的主要危險(xiǎn)因素(P0.05)。結(jié)論:顱內(nèi)血管支架成形術(shù)技術(shù)操作難度較大,同時(shí)也存在較大的風(fēng)險(xiǎn),手術(shù)治療時(shí)應(yīng)慎重;顱外血管支架置入成形術(shù)較顱內(nèi)置入而言可操作性大,成功率高,風(fēng)險(xiǎn)相對(duì)較小。
[Abstract]:Objective: the purpose of this study was to investigate the risk difference of extracranial and extracranial vessels in patients with cerebral vascular stenosis undergoing stenting. By observing the side effects and complications related to stents in perioperative period and one year after perioperative period, we can provide useful information for clinical prevention and reduction of surgical risk. Methods: from 2009 to 2012, 200 patients with extracranial and extracranial vascular stenosis were selected and divided into two groups: internal carotid artery stenosis group and carotid intracranial segment stenosis group, which were treated by stent placement in Cangzhou Central Hospital, Department of Neurology, Cangzhou Central Hospital. Internal carotid artery stenosis group (100 cases) and carotid intracranial segment stenosis group (100 cases). Stent placement points are related to cerebral ischemia events. The technical operation, postoperative complications and 1-year follow-up data of the two groups were analyzed statistically. Results: 1 during perioperative period, all 100 cases of internal carotid artery stenosis were operated successfully, 15 cases of complications were (blood pressure and heart rate decrease) caused by vagus reflex, and cerebral infarction (ischemic stroke) were caused by vagal reflex, respectively, in the group of internal carotid artery stenosis, 100 cases of internal carotid artery stenosis were operated successfully. Subcutaneous hematoma, pseudo-(sexual) layer aneurysm, (transient cerebral ischemia) transient ischemic attack, etc. Among 100 cases of carotid intracranial stenosis, 97 cases were successful and 2 cases died. One case underwent percutaneous transluminal angioplasty after failed stent placement. The success rate and mortality rate were 97%, 2% and 17 cases, respectively. The stenosis rate of internal carotid artery was decreased from (75.68 鹵7.32)% to (12.45 鹵9.34)% after stenting in the group of internal carotid artery stenosis (ICA), including ischemic stroke, dissection of artery, vasospasm, respiration and cardiac arrest, etc. The rate of stenosis in the group of internal carotid artery stenosis was decreased from (75.68 鹵7.32)% to (12.45 鹵9.34)%. The stenosis of intracranial segment of carotid artery decreased from (74.93 鹵11.33)% before treatment to (26.78 鹵13.44)%, and the degree of stenosis was improved (P0.05). 3The patients in internal carotid artery stenosis group were followed up one year after operation, and the rate of stenosis was decreased from (74.93 鹵11.33)% before treatment to (26.78 鹵13.44)% before treatment. Vascular occlusion rate was 2% (2 / 100), new cerebral infarction was 3% (3 / 100), transient cerebral ischemia was 14% (14 / 100), and cerebral hemorrhage rate was 1% (1 / 100). The occlusion rate was 7.14% (7 / 98), the new cerebral infarction was 18.37% (18 / 98) and the transient cerebral ischemia rate was 29.59% (29 / 98). The occlusion rate, new cerebral infarction rate and transient cerebral ischemia rate in the internal carotid artery group were significantly lower than those in the carotid intracranial segment stenosis group (P0.05). There was no significant difference in the rate of cerebral hemorrhage between the two groups (P0.05). (4) the follow-up results showed that there were 6 mild stenosis, 3 moderate stenosis and 1 severe stenosis in the internal carotid artery group one year after operation. The incidence of restenosis was 10% (10 / 100). In the group of intracranial stenosis of carotid artery, 9 cases were mild stenosis, 10 cases were moderate stenosis and 3 cases were severe stenosis. The restenosis rate was 22.45% (22 / 98). The restenosis rate of stent in carotid intracranial segment stenosis group was significantly higher than that in internal carotid artery group 1 year after operation (P0.05). (5) risk factors analysis of extracranial and extracranial artery stenosis showed that the rate of stent restenosis was significantly higher than that of internal carotid artery group. The level of serum HCY was positively correlated with the degree of arterial stenosis (P0.01). The level of serum hr-CRP was positively correlated with the degree of arterial stenosis (P0.05), and the level of serum HDL was negatively correlated with the degree of arterial stenosis (P0.05). The level of serum LDL was positively correlated with the degree of arterial stenosis (P0.05). Logistic regression analysis showed that diabetes mellitus and hypertension were the main risk factors for extracranial and extracranial vascular stenosis (P0.05). Conclusion: the technique of intracranial angioplasty is difficult and there is also a great risk, so we should be careful in surgical treatment, and the operation of extracranial stent implantation is more maneuverable than that of intracranial stenting, the success rate is high, and the risk is relatively small.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 曹群;劉長(zhǎng)喜;宋程光;;癥狀性頸動(dòng)脈狹窄伴有同側(cè)中動(dòng)脈狹窄的介入治療效果研究[J];中國(guó)卒中雜志;2015年07期

2 杜鵑;楊f ;邱忠明;陳光輝;劉新峰;;197例腦梗死合并2型糖尿病患者顱內(nèi)外動(dòng)脈狹窄的研究[J];中華老年心腦血管病雜志;2014年09期

3 鄭麒;劉慶新;;短暫性腦缺血發(fā)作顱內(nèi)動(dòng)脈粥樣硬化的血清CysC水平及其藥物治療評(píng)價(jià)[J];中國(guó)生化藥物雜志;2014年05期

4 支曉東;石向群;;顱內(nèi)動(dòng)脈狹窄支架置入后對(duì)腦動(dòng)脈及其供血腦組織影響的研究進(jìn)展[J];中國(guó)腦血管病雜志;2014年07期

5 蘭晶;曹云鵬;;癥狀性大腦中動(dòng)脈狹窄程度與卒中再發(fā)的Meta分析[J];中風(fēng)與神經(jīng)疾病雜志;2014年04期

6 杜鵑;蔡乾昆;熊云云;代齊良;段立暉;邱忠明;楊f ;徐格林;陳光輝;劉新峰;殷勤;;血管成形術(shù)治療癥狀性顱內(nèi)動(dòng)脈粥樣硬化性狹窄的臨床療效觀察[J];中國(guó)腦血管病雜志;2014年04期

7 孫強(qiáng);孫延鵬;王云甫;;糖化血紅蛋白水平對(duì)糖尿病并發(fā)缺血性腦卒中患者再次腦血管事件的預(yù)測(cè)價(jià)值[J];神經(jīng)損傷與功能重建;2014年02期

8 范曉迪;劉建勛;林成仁;;動(dòng)脈粥樣硬化腦缺血/再灌注動(dòng)物模型的研究進(jìn)展[J];中國(guó)藥理學(xué)通報(bào);2014年03期

9 肖天梅;林澤宏;李樂(lè)愚;麥美琪;曾靜;王本國(guó);;糖尿病前期及糖尿病患者合并顱內(nèi)外血管狹窄的對(duì)比研究[J];中華神經(jīng)醫(yī)學(xué)雜志;2013年11期

10 柳海斌;慕青;;大腦后動(dòng)脈交通前段內(nèi)徑與基底動(dòng)脈內(nèi)徑和頸內(nèi)動(dòng)脈內(nèi)徑之間關(guān)系的MRA評(píng)價(jià)[J];工企醫(yī)刊;2013年05期

相關(guān)碩士學(xué)位論文 前2條

1 董春霞;圍手術(shù)期缺血性腦血管病[D];吉林大學(xué);2013年

2 門(mén)洋;載脂蛋白B、載脂蛋白A1及二者比值與腦動(dòng)脈粥樣硬化的關(guān)系[D];大連醫(yī)科大學(xué);2013年

，

本文編號(hào)：2449664