颈动脉内膜剥脱术后脑血管并发症相关危险因素分析  

Analysis of risk factors for cerebrovascular complications after carotid endarterectomy

作　　者：杨耀国[1] 陈忠[1] 寇镭[1] 唐小斌[1] 吴章敏[1] 刘晖[1] 王盛[1] Yang Yaoguo;Chen Zhong;Kou Lei;Tang Xiaobin;Wu Zhangmin;Liu Hui;Wang Sheng(Department of Vascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院血管外科,北京100029

出　　处：《中华医学杂志》2019年第21期1636-1640,共5页National Medical Journal of China

基　　金：国家自然科学基金(81870340);首都卫生发展科研专项重点攻关项目(2018-1-2062);中国脑卒中高危人群干预适宜技术研究及推广项目(GN-2018R0004).

摘　　要：目的研究颈动脉内膜剥脱术(CEA)后脑血管并发症的相关危险因素,提高CEA在治疗缺血性脑卒中的疗效。方法选取2013年1月至2017年3月首都医科大学附属北京安贞医院血管外科动脉粥样硬化性颈动脉狭窄且行CEA的患者295例进行回顾性分析。结果单因素logistics分析示下肢动脉严重狭窄(RR=5.667,P=0.017)、颈动脉阻断前收缩压(RR=6.659,P=0.010)、阻断前舒张压(RR=3.981,P=0.046)、反流压(RR=5.359,P=0.021)、术毕舒张压(RR=9.550,P=0.002)、术后第1天舒张压(RR=7.932,P=0.005)是CEA术后发生脑血管并发症的影响因素;多因素logistics回归分析发现颈动脉阻断前收缩压(RR=0.953,P=0.024)、反流压与患者基础收缩压的比值(SSI)是否大于0.25(RR=0.086,P=0.049)是CEA术后发生脑血管并发症的独立危险因素。结论颈动脉阻断前收缩压值和SSI是否大于0.25是CEA术后脑血管并发症发生的独立危险因素,加强CEA术后患者的随访和药物治疗,可能有利于减少颈动脉CEA术后再狭窄的发生。Objective To evaluate the related risk factors of cerebrovascular complications after carotid endarterectomy(CEA)and to improve the efficacy of CEA in the treatment of ischemic stroke.Methods The clinical data of 295 patients with atherosclerotic carotid artery stenosis who underwent CEA in the Department of Vascular Surgery,Beijing Anzhen Hospital,Capital Medical University from January 2013 to March 2017 were retrospectively analyzed.Results As the results of the single-factor analysis of logistics,severe lower limb artery stenosis(RR=5.667,P=0.017),systolic blood pressure before the carotid artery clamping(RR=6.659,P=0.010),diastolic blood pressure before the carotid artery clamping(RR=3.981,P=0.046),stump pressure(RR=5.359,P=0.021),diastolic blood pressure after surgery(RR=9.550,P=0.002),diastolic blood pressure of the first day after surgery(RR=7.932,P=0.005)were influencing factors of postoperative cerebrovascular complications after CEA.The results of multi-factor analysis of logistic regression indicated that diastolic blood pressure before the carotid artery clamping(RR=0.953,P=0.024)and stump pressure to basic systolic blood pressure index(SSI)>0.25(RR=0.086,P=0.049)were independent risk factors for postoperative cerebrovascular complications after CEA.Conclusion Systolic blood pressure before carotid artery clamping and SSI>0.25 are independent risk factors for postoperative cerebrovascular complications after CEA.Close follow-up and drug treatment for patients after CEA might be beneficial to reduce postoperative carotid artery restenosis.

关 键 词：颈动脉 颈动脉内膜切除术 危险因素 反流压与基础收缩压比值 

分 类 号：R651.12[医药卫生—外科学]