颈动脉内膜剥脱术治疗老年症状性颈动脉狭窄的研究  

Carotid endarterectomy in treatment of symptomatic carotid artery stenosis in the elderly

作　　者：田磊[1] 关朝聚 陈学东[1] 王中华[1] 张亭亭[1] 王育红[1] 汤楚中[3] 

机构地区：[1]海军总医院普外科 [2]海军91876医院普外科 [3]海军总医院心血管外科

出　　处：《中华老年心脑血管病杂志》2013年第2期126-128,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨颈动脉内膜剥脱术(CEA)在老年症状性颈动脉狭窄中的应用。方法回顾分析我院108例老年症状性颈动脉狭窄行CEA患者的临床资料。结果 108例患者行CEA共125例次,成功率100%,其中颈动脉狭窄60%～75%者48例次,占38.4%,狭窄>75%者77例次,占61.6%,围手术期严重并发症2例,发生率1.9%,围手术期死亡1例,占0.9%。101条颈动脉术后1个月经颈多普勒超声显示,颈内动脉最狭窄处血管内径较术前明显增加[(6.11±1.36mmvs 1.59±0.82mm,P<0.05],狭窄程度由术前的(78±21)%降至(14±12)%,最狭窄处收缩期最大流速明显改善[(208±22)cm/s vs(93±18)cm/s,P<0.05]。81例患者术后18个月脑缺血症状较术前改善者75例(92.6%),再发短暂性脑缺血发作5例(6.2%),脑卒中1例(1.2%),发现术侧颈动脉>60%的再狭窄1例(1.2%),低于北美症状性颈动脉剥脱试验水平。结论 CEA是治疗老年症状性颈动脉狭窄的有效方法,在预防老年患者缺血性脑卒中等重大脑血管事件的发生中有重要价值。Objective To study the application of carotid endarterectomy（CEA） in treatment of symptomatic carotid artery stenosis（CAS） in the elderly. Methods Clinical data about 108 elderly patients with symptomatic CAS who underwent CEA in our hospital were retrospectively ana- lyzed. Results One hundred and twenty-five times of CEA were performed for the 108 patients with an 100% success rate. Of these 125 times of CEA, 48（38.4%） were performed for the pa- tients with their carotid artery stenosis being 60%-75%,77（61.6%） were performed for those with their carotid artery stenosis〉75%. Severe complications occurred in 2（1. 9%） out of the 125 times of CEA and 1 patient（0.9%） died. Doppler ultrasonography showed that the inner di ameter of blood vessels in the most severe carotid artery stenosis was significantly larger,the ste nosis extent was significantly lower,and the maximal blood flow speed was significantly faster af- ter operation than before operation（6.11±1.36 mm vs 1.59±0.82 mm,P〈0.05;14%±12% vs 78%＋21%,P〈0.05;208±22 cm/s vs 93＋18 em/s,P〈0.05）. The cerebral ischemia symptoms were improved in 75（92.6%） ,recurrent transient cerebral ischemia occurred in 5（6. 2%） ,and cer- ebral stroke occurred in 1（1.2%） out of the 81 patients 18 months after operation. In addition,ca- rotid artery restenosis 〉60% was found in 1 patient（1.2%） at the operation side,which was low- er than the NASCET level. Conclusion CEA is an effective procedure for symptomatic CAS in the elderly and plays an important role in the prevention of major cerebrovascular events such as ischemic cerebral stroke in the elderly.

关 键 词：颈动脉狭窄 颈动脉内膜切除术 脑缺血发作 短暂性 阿司匹林 血管造影术 数字减影 

分 类 号：R743.3[医药卫生—神经病学与精神病学]