颈动脉内膜剥脱术治疗脑卒中伴颈动脉轻中度狭窄不稳定斑块的临床研究  

Study of carotid endarterectomy in stroke patients with mild to moderate carotid stenosis and unstable plaque

作　　者：刘胜[1] 赵伦德[1] 尹庆雨 乔磊 金巍 LIU Sheng;ZHAO Lunde;YIN Qingyu;QIAO Lei;JIN Wei(The First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院,河南新乡453100

出　　处：《中国实用神经疾病杂志》2022年第2期188-191,共4页Chinese Journal of Practical Nervous Diseases

基　　金：新乡市科技攻关计划项目(编号:GG2020038)。

摘　　要：目的探讨应用颈动脉内膜剥脱术治疗脑卒中伴颈动脉轻中度狭窄不稳定斑块患者的安全性及临床疗效。方法选取新乡医学院第一附属医院2017-09—2020-09收治的脑卒中伴颈动脉轻中度狭窄不稳定斑块的228例住院患者为研究对象,对照组188例,观察组40例。对照组采用药物保守治疗,观察组在药物保守治疗基础上行颈动脉内膜剥脱术。统计观察组患者术后1个月内手术相关严重心脑血管并发症发生情况,2组患者治疗后3个月、6个月脑卒中复发情况,2组患者治疗前及治疗后1个月、3个月、6个月神经功能缺损情况评价(NIHSS评分),分析观察组手术治疗的安全性及比较2组临床疗效。结果观察组均顺利行颈动脉内膜剥脱手术,术后1个月内均未发生手术相关严重心脑血管并发症;两次随访观察组脑卒中复发率(0、2.5%)均低于对照组(9.6%、15.4%),差异有统计学意义(P<0.05);3次随访观察组NIHSS评分[(8.4±1.7)分、(5.2±1.4)分、(3.4±1.0)分]均较对照组低[(10.2±1.5)分、(7.4±2.0)分、(6.2±2.0)分],差异有统计学意义(P<0.05)。结论颈动脉内膜剥脱术可有效降低脑卒中伴颈动脉轻中度狭窄不稳定斑块患者的卒中复发率,促进神经功能恢复,有良好的手术安全性与临床疗效。Objective To investigate the surgical safety and postoperative clinical efficacy of stroke patients with mild to moderate carotid stenosis and unstable plaque.Methods Totally 228 hospitalized patients with stroke with mild to moderate carotid stenosis and unstable plaque in the First Affiliated Hospital of Xinxiang Medical College from September 2017 to September 2020 were selected as the research objects,and were divided into control group(188 cases)and observation group(40 cases).The control group was treated with the best drug conservative treatment,and the observation group underwent carotid endarterectomy on the basis of the best drug conservative treatment.The occurrence of operation related serious cardiovascular and cerebrovascular complications within 1 month after operation in the observation group,the recurrence of stroke in 3 months and 6 months after treatment in the two groups,the evaluation of neurological deficit(NIHSS score)before and 1 month,3 months and 6 months after treatment in the two groups were counted,and the safety of surgical treatment in the observation group and the clinical efficacy of the two groups were analyzed.Results All patients in the observation group underwent carotid endarterectomy successfully,and no serious cardiovascular and cerebrovascular complications occurred within 1 month after operation.The recurrence rate of stroke in the observation group(0,2.5%)was lower than that in the control group(9.6%,15.4%),and there was a statistically significant difference between the two groups.The average NIHSS score of the observation group(8.4±1.7),(5.2±1.4),(3.4±1.0)was smaller than that of the control group(10.2±1.5),(7.4±2.0),(6.2±2.0)(P<0.05).Conclusion Carotid endarterectomy can be used as a treatment for stroke patients with mild to moderate carotid stenosis and unstable plaque.It can effectively reduce the recurrence rate of stroke and promote the recovery of neurological function.It has good surgical safety and clinical efficacy.

关 键 词：脑卒中 颈动脉内膜剥脱术 颈动脉狭窄 不稳定斑块 

分 类 号：R743.3[医药卫生—神经病学与精神病学]