冠心病合并颈动脉狭窄的治疗  

Treatment of coronary heart diseases and carotid arteriostenosis

作　　者：李庆[1] 孔晴宇[1] 陈忠[2] 朱俊明[1] 刘永民[1] 郑斯宏[1] 唐小斌[2] 许尚栋[1] 孙立忠[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科五病房,100029 [2]首都医科大学附属北京安贞医院血管外科,100029

出　　处：《中华胸心血管外科杂志》2013年第6期371-373,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市科委攻关项目（z09050700620902）

摘　　要：目的探讨冠状动脉旁路移植术（CABG）和颈动脉内膜剥脱术（CEA）治疗冠心病合并颈动脉狭窄的治疗方法的选择。方法2009年1月至2011年12月期间，首都医科大学附属北京安贞医院大血管中心23例冠心病合并颈动脉狭窄患者同期或分期行CABG和CEA治疗，男16例，女7例。年龄53～82岁，平均（65．9±4．0）岁。冠状动脉造影发现左主干病变3例，2支病变3例，3支病变17例。1例合并二尖瓣关闭不全。单侧颈动脉狭窄17例，双侧狭窄6例，直径狭窄I〉70％。依据患者两处病变病情严重程度而采取冠状动脉旁路移植术（CABG）和颈动脉内膜剥脱术（CEA）同期或分期治疗，术后观察围手术期发生卒中、心肌梗死的及死亡情况，并随访。结果7例患者同期行CEA和CABG，其中1例同时行二尖瓣置换；13例患者先期行CABG后行CEA；3例患者先行CEA后行CABG。围术期死亡1例（4．3％），无心绞痛、心肌梗死和卒中。随访6个月，随访期内患者未发生死亡、卒中、心绞痛及心肌梗死。结论同期还是分期行CABG和CEA治疗冠心病合并颈动脉狭窄应根据患者具体情况而定，个性化治疗是降低手术风险的关键。Objective To investigate how to combine carotid endarterectomy （CEA） and coronary artery bypass graft- ing（CABG） on patients with carotid arteriostenosis and coronary heart diseases. Methods Total of 23 consecutive patients with carotid artery stenosis and coronary artery diseases underwent CEA and CABG between January 2009 and December 2011 in Beijing Aortic Center Beijing Anzhen Hospital of Capital Medical University. There were 16 males and 7 females, with their ages ranged from 53 to 82 years [ （65.9 ~ 4.0 ） years ]. 20 patients had at least 3 -vessel coronary artery lesions, and there were 3 cases of left main, and one with mitral valve insufficiency. At least 70% stenosis occurred in 17 patients with unilateral carot- id arteriostenosis, and in 6 patients with bilateral lesion. After assessing and comparing the severity extent of coronary artery le- sion and coronary artery lesion, synchronous or staged CEA and CABG was performed accordingly. The occurrence of stroke, myocardial infarction, and death after operation was observed, and follow-up was carried out in 6 months. Results 7 patients underwent synchronous CEA and CABG （one plus mitral valve replacement） ; 13 underwent CABG then CEA; 3 underwent CEA then CABG. Perioperative death occurred in one patient. None of the patients had stroke or myocardial infarction. During the follow-up period, none of the patients manifested stroke, myocardial infarction or death. Conclusion Therapeutic strategy （synchronous or staged CABG and CEA） should not be fixed unified but be selected in accordance with the specific circum- stance of a patient. Individual treatment is the key to reduce the surgical risk.

关 键 词：冠状动脉分流术 颈动脉内膜剥脱术 冠心病 颈动脉狭窄 

分 类 号：R541.4[医药卫生—心血管疾病]