老年患者颈动脉重度狭窄颈动脉内膜剥脱术与支架置入术的预后比较  

Prognosis of carotid endarterectomy versus stent implantation in elderly patients with severe carotid stenosis

作　　者：田野 黄晓晴 孙鹏举 陈洪山 侯爽 朱司阳 刘俊[1] 王柄森 高志波[1] TIAN Ye;HUANG Xiao-qing;SUN Peng-ju;CHEN Hong-shan;HOU Shuang;ZHU Si-yang;LIU Jun;WANG Bing-sen;GAO Zhi-bo(Fuyang People's Hospital Affiliated to Anhui Medical University,Fuyang 236000,China)

机构地区：[1]安徽医科大学附属阜阳人民医院(阜阳市人民医院),安徽阜阳236000

出　　处：《黑龙江医药科学》2022年第3期17-19,22,共4页Heilongjiang Medicine and Pharmacy

基　　金：阜阳市卫健委课题,编号:FY2019-035。

摘　　要：目的:比较两种手术方式治疗老年患者颈动脉重度狭窄术后疗效。方法:募集2018-08~2020-10在我院行手术治疗的颈动脉重度狭窄的69例老年患者,根据病人血管情况及患者意愿分为两组,即颈动脉内膜剥脱(CEA)组和支架置入术(CAS)组,其中35例于神经外科接受CEA,34例于神经内科接受CAS。两组患者术前及术后均行颈动脉多普勒超声、头颈部CTA或DSA等检查明确诊断,术后随访6个月,记录患者术后6个月的ADL评分、NHISS评分、不良事件发生情况及住院期间总费用,比较两种术式住院总费用、术后6月ADL评分、NHISS评分差异及不良事件发生率。结果:两组的年龄、性别、基础疾病的差异均无统计学意义(P>0.05)。两组的术前术后ADL评分及NHISS评分的差值、住院期间总费用有统计学意义(P<0.05)。两组术后不良事件发生情况的差异无统计学意义(P>0.05)。结论:对于颈动脉重度狭窄的老年患者,CEA及CAS两种术式均有效,CEA组患者术后生活质量改善更有优势,住院期间总费用明显少于CAS组,两组术后不良事件的发生CEA组比CAS组少。Objective:To compare the curative effect of two surgical methods in the treatment of senile patients with severe carotid artery stenosis.Methods:69 elderly patients with severe carotid artery stenosis who underwent surgical treatment in our hospital from August 2018 to October 2020 were recruited and divided into two groups according to their vascular conditions and patients'wishes,namely carotid endarterectomy(CEA)group and stent implantation(CAS)group.Among them,35 patients received CEA in the neurosurgery department.Thirty-four patients received CAS in the Department of Neurology.Patients in both groups received preoperative and postoperative carotid Doppler ultrasound,head and neck CTA or DSA examinations for diagnosis.Postoperative follow-up was conducted for 6 months,and ADL score,NHISS score,the incidence of adverse events and the total cost during hospitalization were recorded.The total hospitalization cost,ADL score,NHISS score at 6 months after operation and the incidence of adverse events were compared between the two procedures.Results:There were no significant differences in age,sex and underlying diseases between the two groups(P>0.05).The difference of ADL score and NHISS score before and after operation and the total cost during hospitalization between the two groups were statistically significant(P<0.05).There was no significant difference in the incidence of postoperative adverse events between the two groups(P>0.05).Conclusion:For elderly patients with severe carotid artery stenosis,CEA and CAS are both effective.CEA group has more advantages in improving postoperative quality of life,and the total cost during hospitalization is significantly less than that of CAS group.The incidence of postoperative adverse events in CEA group was less than that in CAS group(restenosis in 1 case,nerve injury in 2 cases in CEA group;2 cases of restenosis and 2 cases of hyperperfusion injury in CAS group).

关 键 词：颈动脉重度狭窄 颈动脉内膜剥脱术 颈动脉支架置入术 

分 类 号：R654.3[医药卫生—外科学]