颈动脉内膜剥脱术治疗高龄颈动脉狭窄患者效果分析  

Efficacy of carotid endarterectomy for carotid artery stenosis in advanced-age patients

作　　者：张萌[1] 郝继恒 张利勇 张士刚 焦力群[3] 王继跃 

机构地区：[1]泰山医学院聊城临床学院,山东聊城252000 [2]聊城市脑科医院 [3]首都医科大学宣武医院

出　　处：《山东医药》2016年第14期18-20,共3页Shandong Medical Journal

基　　金：国家"十二五"科技支撑计划项目(2011BAI08B04)

摘　　要：目的探讨颈动脉内膜剥脱术（CEA）治疗高龄颈动脉狭窄患者的疗效。方法选择高龄颈动脉狭窄患者113例，年龄70～87岁。术前均严格把握手术指征，详细评估心肺功能、麻醉耐受性，择期行CEA手术治疗。术后1周、6个月行颈动脉彩超测定颈内动脉最狭窄处血管内径、收缩期峰值流速（PSV）及舒张末期流速（EDV），行经颅多普勒测定术侧大脑中动脉峰值流速（SPV）及搏动指数（PI）。术后随访8—23个月观察患者临床症状改善情况，行脑血管造影（DSA）检查评估颈动脉狭窄情况。结果113例患者手术均成功。围手术期无死亡病例。术后1周、6个月颈内动脉最狭窄处血管内径、SPV及PI均较术前增加，PSV及EDV均较术前降低（P均〈0．05）。术后14个月发生手术侧再狭窄1例，给予药物保守治疗。结论通过严格把握手术指征、进行术前评估，对高龄颈动脉狭窄患者行CEA治疗可取得较好的疗效，并有较好的远期效果。Objective To investigate the therapeutic effect of carotid endarterectomy （CEA） in treatment of advanced-age patients with carotid artery stenosis. Methods Totally 113 cases of elderly patients with carotid artery stenosis, aged 70 to 87 years, were selected. We strictly grasped the indications for surgery, assessed the cardiac and pulmonary function carefully as well as anesthesia tolerance, then all the patients underwent elective CEA surgery. One week and 6 months after surgery, carotid color Doppler ultrasound was used to determine the blood vessel diameter at the most stenosis, peak systolic velocity （PSV） and end diastolic velocity （EDV）, and transcranial Doppler to determine the ipsilateral middle cerebral artery peak velocity （SPV） and pulsatility index （PI）. The patients were followed up for 8 to 23 months to ob- serve the improvement of clinical symptoms, and to evaluate the carotid artery stenosis. Results The operation was successful in 113 patients. There was no death in perioperative period. After 1 week and 6 months, the blood vessel diameter at the most stenosis, SPV and PI were significantly increased, PSV and EDV were significantly decreased as compared with before （ all P 〈 0.05 ）. Fourteen months after surgery, 1 case had surgical side re-stenosis and received conservative treatment. Conclusion By strictly grasping the indications of surgery and preoperative evaluation, the CEA in treatment of elderly patients with carotid artery stenosis can achieve good results, and have a good long-term effect.

关 键 词：颈动脉狭窄 颈动脉内膜剥脱术 高龄 

分 类 号：R743[医药卫生—神经病学与精神病学]