机构地区:[1]苏州大学附属第一医院神经外科-颈脑血管超声科,215006 [2]苏州大学附属第一医院神经外科,215006 [3]苏州大学附属第一医院影像科,215006
出 处:《中华神经外科杂志》2020年第11期1151-1155,共5页Chinese Journal of Neurosurgery
基 金:科技部十三五重大专项(2017YFC0114302);江苏省医学创新团队(领军人才)项目(CXTDA2017026);江苏省干部保健科研项目(BJ17010);苏州市民生科技示范工程项目(SS201714,SS201859)。
摘 要:目的分析颈动脉内膜切除术(CEA)治疗动脉粥样硬化性卒中的疗效及其与粥样斑块特征的关系。方法回顾性分析2015年8月至2018年10月苏州大学附属第一医院神经外科采用CEA治疗缺血性卒中患者的临床资料,共61例,均为动脉粥样硬化性颈动脉中-重度狭窄。术前及术后1、3、6、12个月均行血管超声检查。根据术后30 d美国国立卫生研究院卒中量表评分(NIHSS)的变化,将患者分为症状改善组(42例)和未改善组(19例),比较两组的临床资料和粥样硬化斑块特征的差异,分析其对患者术后30 d NIHSS改善的影响;随访再狭窄和卒中的再发情况。结果与症状未改善组比较,症状改善组从出现症状至手术的时间短[中位数(四分位数)分别为45(25,168)d、14(10,96)d],低回声斑块[分别为12/19、28.6%(12/42)]和溃疡型斑块[分别为9/19、11.9%(5/42)]所占的比例低、术中开放颈动脉后大脑中动脉平均血流速度快[分别为(41.2±15.2)、(51.1±14.7)cm/s],差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,低回声斑块(OR=3.963,95%CI:1.037~15.149,P=0.044)和溃疡型斑块(OR=5.657,95%CI:1.258~25.448,P=0.024)是影响患者CEA术后30 d临床症状改善的危险因素。61例患者术后超声随访12~15(13.1±1.2)个月,至末次随访,3例(4.9%)发生术侧颈动脉再狭窄,其中症状改善组1例(中度狭窄),症状未改善组2例(中、重度狭窄各1例);随访期间无一例发生卒中。结论CEA既能部分改善患者的神经系统症状又可预防卒中再发;以低回声为主的斑块和溃疡型斑块是影响卒中患者CEA术后30 d神经系统症状改善的危险因素。Objective To analyze the effect of carotid endarterectomy(CEA)on patients with stroke caused by atherosclerotic plaque and its relationship with the characteristics of atherosclerotic plaque.Methods A retrospective analysis was conducted on the clinical data of 61 stroke patients treated with CEA at Neurosurgery Department of the First Affiliated Hospital of Suzhou University from August 2015 to October 2018.All patients were diagnosed with moderate to severe carotid stenosis caused by atherosclerotic plaque.Vascular ultrasonography was performed before operation and 1,3,6,and 12 months post operation.According to score change based on National Institutes of Health Stroke Scale(NIHSS)at 30 days after surgery,patients were divided into symptom improvement group(42 cases)and non-improvement group(19 cases).The clinical data of the two groups of patients were compared with the characteristics of the plaques caused by atherosclerosis,and their effects on the improvement of NIHSS after 30 days were analyzed.The restenosis and stroke recurrence were followed up.Results The results of univariate analysis showed that compared with the symptom non-improvement group,the improvement group had shorter median time interval from symptom onset to operation[14(10,96)d vs.45(25,168)d],lower proportion of hypoechoic plaque[28.6%(12/42)vs.12/19]and ulcerative plaque[11.9%(5/42)vs.9/19],and faster average blood flow velocity of middle cerebral artery(MVMCA)after intraoperative opening of carotid artery(51.1±14.7 cm/s vs.41.2±15.2 cm/s).The differences were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that hypoechoic plaques(OR=3.963,95%CI:1.037-15.149,P=0.044)and ulcerative plaques(OR=5.657,95%CI:1.258-25.448,P=0.024)were independent risk factors that affected the improvement of clinical symptoms 30 days after CEA in patients with carotid stenosis.For 61 patients,the ultrasound follow-up lasted for 12 to 15 months(13.1±1.2 months).At the last follow-up,3 patients(4.9%)had intraoperative c
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