同期血运重建治疗颈动脉与冠状动脉并存重度狭窄的疗效分析  

Clinical outcomes of synchronous revascularization on patients concomitant carotid and coronary artery severe stenosis

作　　者：樊雪强[1] 刘鹏[1] 叶志东[1] 陈洁[1] 马博[1] 朱爽[1] 甄雅楠[1] 郑夏[1] 王非[1] 林凡[1] 杨煜光[1] 钱松屹[1] 任师颜[1] 王凤林[1] 

机构地区：[1]卫计委中日友好医院心血管外科,北京100029

出　　处：《中华医学杂志》2015年第24期1906-1909,共4页National Medical Journal of China

基　　金：科技部国家国际科技合作专项项目（2013DFA31900）

摘　　要：目的 分析颈动脉及冠状动脉并存重度狭窄患者接受同期血运重建的临床疗效.方法 回顾性分析2012年5月至2014年4月中日友好医院12例颈动脉合并冠状动脉重度狭窄患者资料,其中男10例,女2例,平均年龄（64.5±5.9）岁.统计患者的基本特征、手术方式、围手术期并发症及术后30 d健康调查情况.依据颈动脉处理方式将患者分为手术组和支架组,应用查尔森合并症指数和SF-36量表比较2组患者的基础病情和术后30 d时健康情况,以及住院时间、住院费用、呼吸机时间、术后引流及输血量等情况.结果 12例患者共接受了30条冠状动脉血管重建,8例次颈动脉内膜切除术（CEA）,5例次颈动脉支架植入术（CAS）.1例患者同时接受了冠状动脉旁路移植术及右侧CEA和左侧CAS.术后30 d内出现小卒中2例（16.7％）,一过性脑缺血发作（TIA）1例（8.3％）,胸部切口感染1例.术后11例（91.7％）患者接受成分输血.无心肌梗死及死亡病例.平均住院时间（36.5±25.3）d,术后呼吸机应用时间为（37.5±31.2）h,术后心包及纵隔引流量为（347.92±105.69）ml,术后输注浓缩红细胞4.3U.颈动脉手术组和支架组患者查尔森指数分别为（5.57±1.51）和（4.25±1.50）,差异无统计学意义（f=1.40,P＞0.05）;SF-36量表结果分别为（3.63±1.76）和（5.44±1.05）,差异无统计学意义（t=-1.85,P＞0.05）.2组患者在住院时间、呼吸机应用时间、输血量、术后引流量及住院费用方面差异均无统计学意义（均P＞0.05）.结论 同期血运重建治疗颈动脉及冠状动脉并存重度狭窄患者的近期疗效满意,颈动脉手术组和支架组的临床效果相似.Objective To analyze the outcomes of synchronous revascularization for patients concomitant carotid and coronary artery severe stenosis.Methods From May 2012 to April 2014,12 cases who received one-stage operation was retrospective analyzed,including the characteristics,methods of treatment,perioperative complications and health survey 30 days post procedure.Two subgroups were divided according to the different treatment methods on carotid artery,WIC and SF-36 scale were applied to compare the basic condition and recovery situation between 2 groups,the hospital stay time,costs,ventilation time,drainage and blood transfusion volmne were also be compared.Results Totally 30 coronary vcsscls 8 carotid endarterectomy （CEA） and 5 carotid artery stenting （CAS） were performed on 12 patients.One patient also received coronary artery bypass grafting and bilateral carotid artery revascularization （CEA on right and CAS on left）.Two （16.67%） minor stroke,1 （8.33%） TIA,1 wound infection occurred within 30 days post procedure,and 11 （91.67%） received blood component transfusion.No myocardial infarction and death occured.The average hospital stay time were （36.5 ± 25.3） days,ventilator application （37.5 ± 31.2） hours,postoperative drainage volume from pericardial and mediastinal was （347.92 ± 105.69） ml,infusion of concentrated red cell was 4.3 U.WIC was （5.57 ± 1.51） in CEA and （4.25 ± 1.50） in CAS subgroup,there was no significantly statistical difference （t =1.40,P 〉0.05）.the results of SF-36 was （3.63 ± 1.76） and （5.44 ± 1.05） in CEA and CAS subgroup,there was no significantly statistical difference （t =-1.85,P 〉 0.05）.In hospital stay time,ventilator application time,transfusion and drainage volume,hospitalization costs were also no significant statistical difference between two groups.Conclusions The early outcome of synchronous revascularization on concomitant carotid and coronary severe stenosis disease is satisfactory.The clinical results are similar

关 键 词：同期血运重建 颈动脉与冠状动脉并存重度狭窄 颈动脉内膜切除术 冠状动脉旁路移植术 

分 类 号：R654.3[医药卫生—外科学]