分期行冠状动脉旁路移植术和颈动脉支架植入术对术前脑卒中患者的临床预后研究  

Clinical prognosis of staged coronary artery bypass grafting and carotid stent implantation in patients with preoperative stroke

作　　者：夏琦 骆晨涛 林熠[1] 史昀青[1] 马润华 丁文军[1] XIA Qi;LUO Chentao;LIN Yi;SHI Yunqing;MA Runhua;DING Wenjun(Department of Cardiac Surgery,Zhongshan Hospital,Fudan University,Shanghai,200032,P.R.China)

机构地区：[1]复旦大学附属中山医院心脏外科,上海200032

出　　处：《中国胸心血管外科临床杂志》2022年第5期565-571,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析分期行冠状动脉旁路移植术(coronary artery bypass grafting,CABG)和颈动脉支架植入术(carotid artery stenting,CAS)相较单独行CABG对术前有脑卒中史且合并颈动脉狭窄的冠状动脉粥样硬化性心脏病(冠心病)患者的近期和远期疗效。方法回顾性分析2008—2017年复旦大学附属中山医院心脏外科55例术前有脑卒中史且合并颈动脉狭窄的分期行CABG+CAS和单独行CABG冠心病患者的临床资料,其中男48例、女7例,年龄(67.62±7.06)岁。分期CABG+CAS组有13例患者,单独CABG组有42例患者。比较两组患者在围手术期不良事件发生率和长期生存中的差异,并进行单因素和多因素分析以确定长期不良事件发生的独立危险因素。结果分期CABG+CAS组1例(7.69%)患者发生围手术期不良事件,而单独CABG组有4例(9.52%)患者(P=0.84)。平均随访时间(67.84±37.99)个月,在随访期间,分期CABG+CAS组患者的长期生存率明显高于单独CABG组(P=0.02),分期CABG+CAS术的长期不良事件发生风险为单独CABG术的0.22倍[95%CI(0.05,0.92),P=0.04]。结论分期CABG+CAS在不增加围手术期风险的同时显著改善了患者长期生存预后,是一种安全有效的治疗方案,但仍需要前瞻性随机研究来进一步证实这一发现。Objective To analyze the short-term and long-term efficacy of staged coronary artery bypass grafting(CABG)and carotid artery stenting(CAS)compared with CABG alone in patients with coronary heart disease with preoperative history of stroke and carotid stenosis.Methods We reviewed the clinical data of 55 patients(48 males,7females,aged 67.62±7.06 years)with coronary heart disease and carotid stenosis who had a history of stroke and underwent CABG+CAS or CABG alone in Zhongshan Hospital from 2008 to 2017.There were 13 patients in the staged CABG+CAS group and 42 patients in the CABG alone group.The differences in the incidence of perioperative adverse events and long-term survival between the two groups were studied,and univariate and multivariate analyses were carried out to determine the independent risk factors of long-term adverse events.Results Perioperative adverse events occurred in 1(7.69%)patient of the staged CABG+CAS group,and 4(9.52%)patients of the CABG alone group(P=0.84).During the follow-up period(67.84±37.99 months),the long-term survival rate of patients in the staged CABG+CAS group was significantly higher than that in the CABG alone group(P=0.02).The risk of long-term adverse events in the staged CABG+CAS group was 0.22 times higher than that in the CABG alone group(95%CI 0.05-0.92,P=0.04).Conclusion Staged CABG+CAS can significantly improve the long-term survival prognosis without increasing the perioperative risk.It is a safe and effective treatment,but prospective randomized studies are still needed to further confirm this finding.

关 键 词：分期 颈动脉支架植入术 冠状动脉旁路移植术 冠状动脉粥样硬化性心脏病 颈动脉狭窄 

分 类 号：R654.2[医药卫生—外科学] R651.12[医药卫生—临床医学]