發(fā)布時(shí)間：2018-07-05 18:17

  本文選題：頸內(nèi)動(dòng)脈 + 支架��； 參考：《中華腦科疾病與康復(fù)雜志(電子版)》2016年01期

【摘要】：目的探討頸內(nèi)動(dòng)脈狹窄支架成形術(shù)的適應(yīng)證、手術(shù)方法、臨床效果、安全性以及圍手術(shù)期并發(fā)癥的防治方法。方法選擇2013年1月至2014年6月在我科頸動(dòng)脈狹窄住院患者,其中20例頸內(nèi)動(dòng)脈顱外段狹窄達(dá)到支架成形術(shù)指征(癥狀性頸內(nèi)動(dòng)脈狹窄50%,無(wú)癥狀性狹窄75%)的患者作為治療組,給予支架成形術(shù),同時(shí)選擇20例頸內(nèi)動(dòng)脈狹窄雖然到達(dá)支架成形術(shù)指征,但不愿意接受支架成形術(shù)單純采用保守治療(控制危險(xiǎn)因素+降脂、降壓、控制血糖等藥物對(duì)癥治療)的患者作為對(duì)照組。治療組除給予支架成形術(shù)外,同時(shí)控制危險(xiǎn)因素,降脂、降壓、控制血糖藥物等對(duì)癥治療。手術(shù)前后對(duì)兩組進(jìn)行頸部血管彩色超聲、經(jīng)顱多普勒超聲(TCD)、磁共振血管造影(MRA)、CT灌注(CTP)、數(shù)字減影血管造影(DSA)等檢查,同時(shí)進(jìn)行美國(guó)國(guó)立衛(wèi)生研究院卒中量表(NIHSS)評(píng)分和日常生活能力(ADL)評(píng)分、6個(gè)月內(nèi)再發(fā)卒中的調(diào)查等,對(duì)有關(guān)結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果治療組支架置入術(shù)成功率100%。頸動(dòng)脈支架成形術(shù)后3周測(cè)量狹窄程度由原來(lái)的(87.65±7.63)%下降至(12.58±4.83)%(P0.01)。5例發(fā)生短暫性血壓及心率下降,8例發(fā)生持續(xù)性低血壓及心率下降。6例圍手術(shù)期出現(xiàn)過(guò)度灌注表現(xiàn),無(wú)腦出血等嚴(yán)重并發(fā)癥;治療組手術(shù)前后腦血流量(CBF)、腦血容量(CBV)明顯改善(P0.05);治療組隨訪6個(gè)月,術(shù)后無(wú)支架內(nèi)再狹窄;治療組ADL評(píng)分、NIHSS評(píng)分均優(yōu)于對(duì)照組(P0.05);治療組在6個(gè)月內(nèi)無(wú)再發(fā)卒中,而對(duì)照組有4例發(fā)生卒中(P0.05),差異有統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論頸動(dòng)脈狹窄支架成形術(shù)臨床效果好,術(shù)后支架內(nèi)再發(fā)狹窄率低,能夠明顯改善患者生活質(zhì)量及預(yù)防再發(fā)卒中,明顯優(yōu)于內(nèi)科藥物保守治療。
[Abstract]:Objective to investigate the indications, surgical methods, clinical effects, safety and perioperative complications of stent angioplasty for internal carotid artery stenosis. Methods from January 2013 to June 2014, 20 patients with extracranial stenosis of internal carotid artery (50% symptomatic internal carotid artery stenosis, 75% asymptomatic stenosis) were selected as treatment group, and 20 patients with extracranial stenosis of internal carotid artery reached the indication of stent angioplasty (50% of symptomatic internal carotid artery stenosis, 75% of asymptomatic stenosis). Stent angioplasty was given, and 20 cases of internal carotid artery stenosis were selected to reach the indications of stent angioplasty, but they were not willing to be treated with conservative treatment (controlling risk factors, lowering blood pressure, lipid lowering). Control of blood sugar and other drugs for symptomatic treatment) of the patients as a control group. In addition to stenting, the treatment group also controlled risk factors, lipid, blood pressure, blood sugar control drugs and other symptomatic treatment. The two groups were examined by color ultrasound, transcranial Doppler ultrasound (TCD), magnetic resonance angiography (MRA) CT perfusion (CTP) and digital subtraction angiography (DSA) before and after operation. The National Institutes of Health Stroke scale (NIHSS) and activities of Daily living (ADL) were also evaluated. Results the success rate of stent implantation in treatment group was 100%. The degree of stenosis was decreased from (87.65 鹵7.63)% to (12.58 鹵4.83)% (P0.01) at 3 weeks after carotid stenting. Transient hypotension and heart rate decline occurred in 8 patients with persistent hypotension and decreased heart rate in 6 patients. The cerebral blood flow (CBF) and cerebral blood volume (CBV) were significantly improved before and after operation in the treatment group (P0.05), and the patients in the treatment group were followed up for 6 months without stent restenosis. The ADL score of the treatment group was better than that of the control group (P0.05); the treatment group had no recurrent stroke within 6 months, while the control group had 4 cases of stroke (P0.05), the difference was statistically significant (P0.01). Conclusion Stent angioplasty of carotid artery stenosis has good clinical effect and low rate of recanalization of stent after operation. It can obviously improve the quality of life of patients and prevent recurrent stroke, which is obviously superior to conservative treatment of internal medicine.
【作者單位】： 解放軍第二六四醫(yī)院神經(jīng)外科;
【基金】：2012年山西省科技攻關(guān)課題(20120313018-2)
【分類號(hào)】：R651.12

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