颈动脉重度狭窄合并冠状动脉病变的联合手术  

Simultaneous treatments in patients with severe carotid artery stenosis and coronary artery disease

作　　者：张玉坤 赵阳 金蔚涛 叶迅[2] 陈晓霖[2] 张文超 曾春[2] 赵元立[2] 王嵘[2] Zhang Yukun;Zhao Yang;Jin Weitao;Ye Xun;Chen Xiaolin;Zhang Wenchao;Zeng Chun;Zhao Yuanli;Wang Rong(Department of Neurosurgery,Peking University International Hospital,Beijing 102206,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Cardiology,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院神经外科,北京102206 [2]首都医科大学附属北京天坛医院神经外科,北京100070 [3]北京大学国际医院心血管内科,北京102206

出　　处：《中华医学杂志》2019年第39期3077-3080,共4页National Medical Journal of China

摘　　要：目的分析心脑联合手术在颈动脉重度狭窄合并冠状动脉病变患者诊疗过程中的应用,论证该技术有利于降低上述疾病围手术期心脑血管主要不良事件的发生。方法北京大学国际医院心脑联合诊疗团队于2017年9月至2019年2月为37例符合入组条件的患者行心脑联合诊断治疗,经过心脑联合数字减影血管造影(DSA),12例确诊为颈动脉重度狭窄合并冠状动脉病变,对其行心脑联合手术,并对治疗效果进行了回顾性分析。结果组内颈动脉狭窄合并冠状动脉病变患者心脑联合DSA确诊率59.5%(22/37),颈动脉中重度狭窄率、冠状动脉多支病变率均为77.3%(17/22)。其中,颈动脉重度狭窄并冠状动脉病变率54.5%(12/22),同期行介入或外科干预率83.3%(10/12)。统计其围手术期的心脑血管主要不良事件,9例术后临床症状改善良好,1例冠状动脉旁路移植手术的患者术后出现脑缺血卒中事件,2例自行要求保守治疗患者原发症状未及改善。结论心脑联合手术显示颈动脉狭窄程度同冠状动脉病变呈正相关,不仅可以同时精确评估颈动脉重度狭窄合并冠状动脉病变的情况,而且能够快速地完成诊断治疗工作,缩短诊断治疗时间,降低围手术期心脑血管主要不良事件。Objective To implement simultaneous treatments in patients with severe carotid artery stenosis and coronary artery disease(CAD),we sought to investigate its efficacy of reducing perioperative major adverse cardiac and cerebrovascular event(MACCE).Methods Brain-and-Heart treatment team in Peking University International Hospital performed hybrid Digital Substraction Angiography(DSA)of carotid artery and coronary artery for 37 patients meeting the group criterion from September 2017 to February 2019.Twelve patients were diagnosed and received simultaneous treatments of severe carotid artery stenosis and coronary artery disease after hybrid DSA.We conducted the retrospective study and made analysis of these patients.Results The diagnosis rate by simultaneous treatmentsin patients with carotid artery stenosis and coronary artery disease is 59.5%(22/37),the rate of severe carotid artery stenosis or multi-vessel CAD is 77.3%(17/22).The rate of severe carotid artery stenosis with CAD is 54.5%(12/22),therate of simultaneous treatmentsis 83.3%(10/12).Nine patients post-operative symptoms release,one patient with ischemic stroke after CABG,and two patients of medical therapy with stable symptoms.Conclusion Simultaneous treatments in patients with severe carotid artery stenosis and coronary artery disease not only reveal the positive correlation between carotid stenosis and CAD,but also accurately evaluate severity degree or rapidly formulate scheme and reduce MACCE.

关 键 词：颈动脉狭窄 冠状动脉病变 联合手术 心脑血管主要不良事件 

分 类 号：R54[医药卫生—心血管疾病]