颈动脉内膜剥脱术治疗老年颈动脉狭窄患者的危险因素分析  

Risk factors for carotid endarterectomy in elder patients with carotid artery stenosis

作　　者：刁永鹏[1] 刘昌伟[1] 宋小军[1] 李拥军[1] 陈跃鑫[1] 郭李龙[1] 郑月宏[1] 叶炜[1] 刘暴[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院血管外科,100730

出　　处：《中华普通外科杂志》2014年第6期448-451,共4页Chinese Journal of General Surgery

摘　　要：目的 分析颈动脉内膜剥脱术（carotid endarterectomy,CEA）治疗老年（≥65岁）颅外段颈动脉狭窄患者的相关危险因素.方法 回顾性分析北京协和医院2009年10月至2012年10月行CEA治疗的312例颈动脉狭窄患者资料,采用单因素及多因素Logistic回归分析,分析影响老年患者手术并发症和预后的相关危险因素.结果 共纳入145例患者,平均随访时间（22±9）个月.其中男116例,女29例,平均年龄（72±4）岁,双侧病变患者51例,无症状患者41例,共施行158例次CEA,105例采用人工血管补片,69例术中使用转流管,平均住院时间（17±5）d.多因素Logistic分析显示：颈动脉阻断时间（OR=0.926,95％ CI：0.875～0.981）、冠心病（OR =5.117,95％ CI：1.197 ～21.866）和外周血管病（OR =4.801,95％ CI：1.121 ～ 20.564）是手术并发症的独立危险因素;高同型半胱氨酸血症（OR=6.452,95％ CI：1.140 ～ 36.519）是术后再狭窄和脑梗死的独立危险因素.结论 颈动脉阻断时间长、合并冠心病和外周血管病增加老年颈动脉狭窄患者的CEA手术风险,高同型半胱氨酸血症是CEA术后再狭窄和脑梗死的危险因素.Objective To analyze the risk factors for carotid endarterectomy （CEA） in elder patients of carotid artery stenosis（CAS）.Methods Clinical data of 312 CAS cases undergoing CEA from Oct 2009 to Oct 2012 were analyzed.The univariate and multivariate Logistic regression analyses were used to analyze the risk factors predicting the complications and prognosis of CEA.Results One hundred fortyfive cases were brought into the research.The mean follow-up was （22 ±9） months.There were 116 males and 29 females.The mean age was （72 ±4） years.Fifty-one cases were with bilateral lesions,and 41 cases were asymptomatic.A total of 158 CEA procedures were successfully performed.One hundred and five artificial vascular patches and 69 shunts were used.The mean hospital stay was （17 ± 5） days.Multivariate Logistic regression showed carotid artery clamping time（OR =0.926,95％ CI：0.875-0.981）,coronary atherosclerotic heart disease（OR =5.117,95％ CI：1.197-21.866） and peripheral arterial disease （OR =4.801,95％ CI：1.121-20.564 were the independent risk factors for surgical complications,and hyperhomocysteinemia （OR =6.452,95％ CI：1.140-36.519） was the independent risk factor for restenosis and stroke after CEA.Conclusions The clamping time of carotid artery,coronary atherosclerotic heart disease and peripheral arterial disease increase the risk of CEA in the elders.Hyperhomocysteinemia was the independent risk factor for restenosis and stroke after CEA.

关 键 词：颈动脉狭窄 颈动脉内膜切除术 手术后并发症 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]