颈动脉转流用于改善颈动脉内膜切除术后脑缺血再灌注损伤研究  

Study on carotid artery shunting for improving cerebral ischemia-reperfusion injury after carotid endarterectomy

作　　者：宋丽佳 马佳其 王璐 屈晓鹏 刘备 SONG Lijia;MA Jiaqi;WANG Lu;QU Xiaopeng;LIU Bei(Department of Pediatrics,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China;Department of Neurosurgery,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学唐都医院儿科,陕西西安710038 [2]空军军医大学唐都医院神经外科,陕西西安710038

出　　处：《空军军医大学学报》2025年第2期205-208,213,共5页Journal of Air Force Medical University

基　　金：国家自然科学基金(81971206)。

摘　　要：目的探讨颈动脉转流是否能减轻颈动脉内膜切除术(CEA)后脑缺血再灌注损伤(IRI)。方法本研究是一项观察性病例对照研究,在空军军医大学唐都医院的卒中建设中心数据库中收集2019年1月至2022年12月在医院神经外科接受CEA手术的患者,共340例分为两组,转流组包括142例进行颈动脉转流处理的患者,对照组包括198例未进行颈动脉转流处理的患者。颈动脉转流技术的适应证为:双侧颈内动脉(ICA)重度狭窄(>70%)、ICA重度狭窄(>70%)伴对侧ICA闭塞和ICA亚闭塞。比较两组患者的院内和术后早期卒中、术后IRI和神经系统发病率。结果与对照组相比,转流组患者的颅神经损伤出现频率显著升高(6.3%vs 2.8%)。转流组患者CEA术后的IRI概率显著低于对照组(P=0.02)。术后随访期间,两组患者卒中、死亡率和血管再狭窄均无明显差异。结论本研究结果表明,与对照组相比,颈动脉转流显著降低了高危患者CEA术后脑IRI的发生率。Objective To investigate whether carotid artery shunting can reduce cerebral ischemia-reperfusion injury(IRI) after carotid endarterectomy(CEA).Methods This study was an observational case-control study.Patients who underwent CEA in the Department of Neurosurgery from January 2019 to December 2022 were collected in the Stroke Construction Center database of Tangdu Hospital,Air Force Medical University.A total of 340 patients were divided into two groups.The shunting group included 142 patients who underwent carotid artery shunting,while the control group included 198 patients who did not undergo carotid artery shunting.The indications for carotid artery shunting were severe bilateral internal carotid artery(ICA) stenosis(>70%),severe ICA stenosis(>70%) with contralateral ICA occlusion,and ICA subocclusion.The incidence of in-hospital and early postoperative stroke,postoperative IRI,and neurological system were compared between the two groups.Results Cranial nerve injury occurred significantly more frequently in patients in the shunt group compared with the control group(6.3% vs 2.8%).The incidence of postoperative IRI after CEA in the shunt group was significantly lower than that in the control group(P=0.02).During the postoperative follow-up,there were no significant differences in stroke,mortality,and vascular restenosis between the two groups.Conclusion Our findings suggest that carotid artery shunting significantly reduces the incidence of cerebral IRI after CEA in high-risk patients compared with the control group.

关 键 词：颈动脉内膜切除术 颈动脉转流 缺血再灌注 卒中 

分 类 号：R651.12[医药卫生—外科学]