颈动脉内膜剥脱术围手术期不良事件及影响因素分析  

Analysis of perioperative adverse events and influencing factors in carotid artery stenosis carotid endarterectomy

作　　者：郭呈龙 夏经钢[1] 尹春琳[1] Guo Chenglong;Xia Jinggang;Yin Chunlin(Department of Cardiology,Xuanwu Hospital,Capital Medical University,Bejing 100053,China)

机构地区：[1]首都医科大学宣武医院心脏内科,北京100053

出　　处：《中国医师进修杂志》2024年第5期445-450,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的观察颈动脉狭窄患者颈动脉内膜剥脱术围手术期不良事件发生情况及其影响因素。方法回顾性分析首都医科大学宣武医院2021年10月至2022年10月120例行颈动脉内膜剥脱术治疗的颈动脉狭窄患者的临床资料。其中,围手术期发生不良事件42例(不良事件组),未发生围手术期不良事件78例(非不良事件组)。记录患者的基线资料、影像学表现、实验室指标、手术指标和术后并发症。采用多因素Logistic回归分析影响行颈动脉内膜剥脱术的颈动脉狭窄患者发生围手术期不良事件的独立危险因素。结果不良事件组脑血管疾病率、大脑前动脉重度狭窄或闭塞率、使用补片率和斑块溃疡率明显高于非不良事件组[35.71%(15/42)比15.38%(12/78)、52.38%(22/42)比26.92%(21/78)、50.00%(21/42)比20.51%(16/78)和61.90%(26/42)比24.36%(19/78)],差异有统计学意义(P<0.05或<0.01)。多因素Logistic回归分析结果显示,大脑前动脉重度狭窄或闭塞、使用补片、斑块溃疡是行颈动脉内膜剥脱术的颈动脉狭窄患者发生围手术期不良事件的独立危险因素(OR=2.874、2.632和3.214,95%CI 1.421~3.654、1.748~3.287和2.101~4.697,P<0.05或<0.01)。结论存在大脑前动脉重度狭窄或闭塞、使用补片和斑块溃疡是影响行颈动脉内膜剥脱术的颈动脉狭窄患者发生围手术期不良事件的独立危险因素,有针对性采取有效措施可预防不良事件的发生,有效降低致残率和致死率。Objective To observe the occurrence of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis,and analyze the influencing factors of perioperative adverse events.Methods The clinical data of 120 carotid artery stenosis patients underwent carotid endarterectomy from October 2021 to October 2022 in Xuanwu Hospital,Capital Medical University were retrospectively analyzed.Among them,42 patients experienced perioperative adverse events(adverse events group),and 78 patients did not experience perioperative adverse events(non-adverse events group).The baseline data,imaging findings,laboratory indexes,surgical indexes and postoperative complications were recorded.Multivariate Logistic regression was used to analyze the independent risk factors of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis.ResultsThe rates of history of cerebrovascular disease,severe stenosis or occlusion of anterior cerebral artery,patch repair and plaque ulceration in adverse events group were significantly higher than those in non-adverse events group:35.71%(15/42)vs.15.38%(12/78),52.38%(22/42)vs.26.92%(21/78),50.00%(21/42)vs.20.51%(16/78)and 61.90%(26/42)vs.24.36%(19/78),and there were statistical differences(P<0.05 or<0.01).Multivariate Logistic regression analysis result showed that the severe stenosis or occlusion of anterior cerebral artery,patch repair and plaque ulceration were the independent risk factors of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis(OR=2.874,2.632 and 3.214;95%CI 1.421 to 3.654,1.748 to 3.287 and 2.101 to 4.697;P<0.05 or<0.01).Conclusions The severe stenosis or occlusion of anterior cerebral artery,patch repair and plaque ulceration are the independent risk factors of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis.Identifying and taking effective measures to prevent the perioperative adverse events can effectively reduce disability an

关 键 词：颈动脉狭窄 颈动脉内膜切除术 手术中并发症 危险因素 

分 类 号：R653[医药卫生—外科学]