颈动脉内膜切除术后早期并发症及影响因素  

Retrospective study for the risk factors of the early complication after carotid endarterectomy

作　　者：张利勇[1] 尹国阳[1] 王继跃[1] 焦力群[2] 陈东[3] 万晓楠[3] 石军伟[3] 凌锋[2] 

机构地区：[1]山东省聊城市人民医院神经外科,252000 [2]首都医科大学宣武医院神经外科 [3]大连市中心医院神经外科

出　　处：《中华外科杂志》2015年第7期533-537,共5页Chinese Journal of Surgery

摘　　要：目的 分析颈动脉内膜切除术后早期并发症的原因及其影响因素.方法 回顾性分析2001年1月至2011年12月首都医科大学宣武医院、聊城市人民医院、大连市中心医院三家医院共494例连续颈动脉内膜切除术的患者资料,其中15例患者分期行双侧手术,共509例次.男性422例,女性72例,年龄35 ～ 84岁,平均（64±9）岁.分析颈动脉内膜切除术后30 d内的各种并发症及原因,着重分析30 d主要并发症的危险因素.使用卡方单因素分析,对患者人群的基本特征、临床特点及术中细节等每一个变量和术后早期不良事件之间的关系进行分析,使用Logistic回归分析评估患者各个因素之间的相关影响与术后30 d内并发症的相关性.结果 本组病例手术完成率为98.6％,7例完全闭塞的患者没有再通.术后30 d内,发生主要并发症有20例（3.9％）,死亡6例（1.2％）,脑梗死9例（1.8％）,脑出血5例（1.0％）;次要并发症120例（23.6％）.单因素分析结果显示,患者改良Rankin量表（mRS）评分≥3分者术后早期并发症率发生率明显增高（χ^2=20.517,P＜O.01）.多因素Logistic回归分析显示,吸烟（OR=2.667,95％ CI：1.048～6.791,P=0.040）及mRS评分≥3分者（OR=8.690,95％ CI：3.279～23.031,P=0.000）术后30 d内主要并发症发生率显著增高.结论 颈动脉内膜切除术的安全性较高,术后发生并发症的概率较低.吸烟和mRS评分≥3分的患者接受颈动脉内膜切除术治疗,围手术期并发症发生率显著增高.Objective To review the influencing factors of the early complication after carotid endarterectomy （CEA）.Methods Retrospective analysis of clinical data of 509 cases received CEA in Xuan Wu Hospital of Capital Medical University,Liaocheng People＇s Hospital and Dalian Central Hospital from January 2001 to December 2011.There are 422 male patients and 72 female patients among the 494 patients,15 patients underwent CEA by stages.The patients were between 35-84 years old,and the mean age was （64 ± 9）years.The complications within 30 days after CEA were analyzed,and find the risk factors for the major adverse events.Chi-square analysis was performed to analyze the correlation between the each variable of the basic characteristics of population,clinical features and intraoperative data and early adverse events after CEA.Logistic regression analysis was used to assess the relationship between a variety of factors and the postoperative complications within 30 days.Results Technical complete rate of 98.6%,7 cases of near-total occlusion patients could not been recanalized.Major complications in 30 days after CEA occurred in 20 cases（3.9%）,including 6 cases of deaths（1.2%）,9 cases of cerebral infarction（1.8%） and 5 cases of cerebral hemorrhage（1.0%）.Secondary complications occurred in 120 cases （23.6%）.Univariate analysis showed modified Rankin scale （mRS） ≥ 3 on the incidence of early postoperative complication had significantly difference （χ^2 =20.517,P 〈 0.01）,multivariate logistic regression analysis revealed that smoking （OR =2.667,95% CI：1.048-6.791,P =0.040） and mRS ≥ 3 （OR =8.690,95% CI：3.279-23.031,P =0.000） were the significant predictors of 30 days of the end event.Conclusion The complications after CEA are uncommon,the security is proved.Smoking and mRS≥3 can increase the risk of CEA.

关 键 词：颈动脉内膜切除术 手术后并发症 颈动脉狭窄 危险因素 

分 类 号：R654.3[医药卫生—外科学]