单侧颈内动脉颅外段中-重度狭窄患者颈动脉内膜切除术后早期神经功能改善的影响因素分析  

Analysis of influencing factors on early neurological function improvement after carotid endarterectomy in patients with moderate to severe extracranial stenosis of unilateral internal carotid artery

作　　者：丁亚芳[1] 惠品晶[1] 蔡忻懿 方璐璐 黄亚波[2] Ding Yafang;Hui Pinjing;Cai Xinyi;Fang Lulu;Huang Yabo(Cervical and Cerebrovascular Ultrasound Department,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;不详)

机构地区：[1]苏州大学附属第一医院颈脑血管超声科,215006 [2]苏州大学附属第一医院神经外科,215006

出　　处：《中国脑血管病杂志》2024年第2期73-84,共12页Chinese Journal of Cerebrovascular Diseases

基　　金：苏州市民生科技项目(SS202061);苏州大学技术开发合作项目(H211064)。

摘　　要：目的探讨单侧颈内动脉颅外段中-重度狭窄患者行颈动脉内膜切除术(CEA)后早期神经功能改善的影响因素。方法回顾性连续纳入2017年1月至2023年6月苏州大学附属第一医院神经外科因单侧颈内动脉中-重度狭窄行CEA且随访资料完整的患者145例。根据患者CEA术后24 h美国国立卫生研究院卒中量表(NIHSS)评分与术前NIHSS评分的差值(ΔNIHSS评分)将所有患者分为神经功能改善组(ΔNIHSS评分≥2分或术后24 h NIHSS评分0分)和神经功能未改善组(ΔNIHSS评分<2分)。收集所有患者的临床资料及影像学资料并进行组间比较。临床资料包括年龄、性别、高血压病、糖尿病、冠心病史、吸烟史、术前临床表现[短暂性脑缺血发作、卒中、无症状]及术前收缩压、舒张压、血脂异常、血生化指标(高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、三酰甘油、总胆固醇、空腹血糖、超敏C反应蛋白)。收集患者CEA术前、术后24 h NHISS评分及术前改良Rankin量表(mRS)评分。影像学资料包括术前颈动脉血管超声及CT血管成像评估的颈动脉狭窄程度(中度狭窄为狭窄率50%~69%,重度狭窄为狭窄率70%~99%)、斑块回声(以低回声为主、以中等回声为主、以高回声为主)、纤维帽完整性(完整、不完整)、是否为溃疡型斑块、是否钙化及钙化位置(表面、基底部)以及术前和术后1周、1个月及3个月经颅多普勒超声检测的患侧大脑中动脉(MCA)血流动力学参数[平均血流速度(Vm)、血管搏动指数(PI)]。组内比较手术前后不同时间点的患侧MCA血流动力学参数。对两组临床资料、影像学资料进行单因素分析,将P<0.05的参数纳入多因素Logistic回归分析,探讨CEA术后早期神经功能改善的影响因素。以多因素Logistic回归分析结果中P<0.05的参数建立简化的预测模型,绘制受试者工作特征曲线并计算曲线下面积(AUC),判断相关影响因素及预测�Objective To explore the correlation between the characteristics of carotid artery plaques and the improvement of neurological function in patients with moderate to severe stenosis of the extracranial segment of the unilateral internal carotid artery after carotid endarterectomy(CEA).Methods A retrospective study was conducted on 145 patients who underwent CEA with complete follow-up data due to moderate to severe stenosis of the unilateral internal carotid artery in the Neurosurgery Department of the First Affiliated Hospital of Soochow University from January 2017 to June 2023.According to the difference between the National Institutes of Health stroke scale(NIHSS)score preoperative and NIHSS score at 24 hours post CEA(ΔNIHSS score),the patients are divided into a group with improved neurological function(ΔNIHSS score≥2 points or postoperative 24 hours NIHSS score was 0 point)and group with no improvement in neurological function(ΔNIHSS score<2 points).Collect clinical and imaging data from all patients and compare them between groups.Clinical data include age,gender,hypertension,diabetes,history of coronary heart disease,smoking history,preoperative clinical manifestations(transient ischemic attack,stroke,asymptomatic),preoperative systolic blood pressure,diastolic blood pressure,dyslipidemia,blood biochemical indicators(high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,triacylglycerol,total cholesterol,fasting blood glucose,hypersensitive C-reactive protein).Patient information regarding CEA preoperative and 24-hour postoperative NHISS scores,as well as preoperative modified Rankin scale(mRS)scores were collected.The imaging data includes preoperative carotid artery ultrasound and CT angiography evaluation of the degree of carotid artery stenosis(moderate stenosis with a stenosis rate of 50%to 69%,severe stenosis with a stenosis rate of 70%to 99%),plaque echo(mainly low echo,mainly medium echo,mainly high echo),fibrous cap integrity(complete or incomplete),whether it is an ulcerati

关 键 词：颈动脉狭窄 粥样硬化斑块特征 颈动脉内膜切除术 早期神经功能预后 

分 类 号：R651.12[医药卫生—外科学]