颈动脉支架成形术与颈动脉内膜剥脱术对缺血性脑卒中患者脑血流灌注情况及预后的影响  

Effect of carotid artery stenting and carotid endarterectomy on cerebral blood perfusion status and prognosis in patients with ischemic stroke

作　　者：毛晶 薛晋峰 王斌 赵丰丽 Mao Jing;Xue Jinfeng;Wang Bin;Zhao Fengli(Department of Neurology,Yuncheng Central Hospital,Yuncheng 044000,Shanxi,China;Department of Intervention,Yuncheng Central Hospital,Yuncheng 044000,Shanxi,China)

机构地区：[1]运城市中心医院神经内科,山西运城044000 [2]运城市中心医院介入科,山西运城044000

出　　处：《血管与腔内血管外科杂志》2022年第7期872-876,共5页Journal of Vascular and Endovascular Surgery

基　　金：山西省医学重点科研项目(2020XM59)。

摘　　要：目的观察颈动脉支架成形术(CAS)与颈动脉内膜剥脱术(CEA)对缺血性脑卒中患者脑血流灌注情况及预后的影响。方法收集2018年6月至2020年12月运城市中心医院收治的141例缺血性脑卒中患者,根据手术方式的不同将其分为CAS组(n=102)与CEA组(n=39)。比较两组患者的临床疗效,分析手术前后两组患者的脑部血流情况[颈内动脉收缩期峰值流速(ICA-PSV)、阻力指数(ICA-RI)、大脑中动脉收缩期峰值流速(MCA-PSV)、搏动指数(MCA-PI)、脑血管反映性(CVR)]及神经功能[血清5-羟色胺(5-HT)、γ-氨基丁酸(GABA)、简易智力状态量表(MMSE)、神经功能缺损程度评分(NIHSS)]。记录两组患者术后30 d内并发症发生率,统计术后1年的随访结果。结果治疗期间及术后30 d内两组均无死亡患者。术后,CAS组患者ICA-PSV、MCA-PSV、CVR、5-HT水平、GABA水平、MMSE评分均高于CEA组,MCA-PI、ICA-RI及NIHSS均低于CEA组,差异均有统计学意义(P<0.05)。CAS组患者并发症总发生率为2.94%,低于CEA组患者的20.48%,差异有统计学意义(P<0.05),两组患者所有并发症经对症处理后均好转。结论CAS与CEA在颈动脉狭窄引起的缺血性脑卒中患者中具有较高的应用价值,但CAS可有效改善患者脑部血流灌注、神经功能、认知功能,且可有效减少术后并发症。Objective To observe the effects of carotid artery stenting(CAS)and carotid endarterectomy(CEA)on cerebral blood perfusion status and prognosis in patients with ischemic stroke.Method The clinical data of 141 patients with ischemic stroke admitted to Yuncheng Central Hospital from June 2018 to December 2020 were collected.They were divided into CAS group(n=102)and CEA group(n=39)according to the different surgical methods.The clinical effects of the two groups were compared,the cerebral blood flow[internal carotid artery systolic peak velocity(ICAPSV),resistance index(ICA-RI),middle cerebral artery-peak systolic velocity(MCA-PSV),middle cerebral arterypulsatility index(MCA-PI),cerebrovascular reactivity(CVR)],and neurological function[5-hydroxytryptamine(5-HT),gamma-aminobutyric acid(GABA),mini-mental state examination(MMSE),national institutes of health stroke scale(NIHSS)]of the two groups before and after operation were analyzed.The complication rate of the two groups within 30 d after operation was recorded,and the follow-up results of one year after operation were counted.Result During treatment and at 30 d after surgery,there were no deaths in the two groups.After treatment,the ICA-PSV,MCA-PSV,CVR,5-HT level,GABA level and MMSE score in CAS group were higher than those in CEA group,while the MCA-PI,ICA-RI and NIHSS in CAS group were lower than those in CEA group,the differences were statistically significant(P<0.05).The total incidence of complications in CAS group was 2.94%,lower than that in CEA group(20.48%),the difference was statistically significant(P<0.05).All complications in the two groups were improved after symptomatic treatment.Conclusion CAS and CEA have high application value in patients with ischemic stroke caused by carotid artery stenosis,but CAS can effectively improve the cerebral blood perfusion,neurological function and cognitive function,and effectively reduce the postoperative complications.

关 键 词：颈动脉支架成形术 颈动脉内膜剥脱术 缺血性脑卒中 脑血流灌注 预后 

分 类 号：R543[医药卫生—心血管疾病]