摘要
目的探讨不同程度神经功能缺失的老年（〉70岁）颈动脉狭窄患者行颈动脉内膜切除术（CZA）的安全性和疗效。方法选取聊城市脑科医院血管神经外科自2008年5月至2015年4月收治的126例患者行CEA手术的病例资料进行分析，其中7例分期行双侧CEA，以2例单独病例计算．共计行CEA手术133例次。按照术前改良Rankin评分（rags）评估神经功能的结果将133例次患者手术资料分为2组，其中mRs评分〈3分组107例次，mRs评分≥3分组26例次。随访9～18个月，平均12-3个月。回顾性分析2组患者的临床资料，对比2组患者在手术安全性和疗效方面差异。结果（1）133例次手术均成功。mRS评分≥3分组中1例患者出现术侧脑梗死，死于脑疝：mRs评分≥3分组术后30d内卒中发生率高于mRS评分〈3分组，差异有统计学意义（P〈0．05）。（2）2组患者术后1个月行颈动脉彩超示颈内动脉最狭窄处血管内径较术前明显增加，收缩期峰值流速及舒张末期流速明显改善，2组患者在改善程度上差异无统计学意义（P＞0．05）。（3）长期随访期间，mRs评分〈3分组的107例患者中2例患者非脑卒中原因病故，余105例患者中有4例出现术后再狭窄，其中1例再狭窄患者出现短暂性脑缺血发作（TIA），经药物治疗后好转，另3例患者未出现TIA。mRS评分≥3分组中1例患者出现术后再狭窄，但无TIA。2组患者在再狭窄和缺血发作上差异无统计学意义（P＞0．05）。结论CEA对术前mRs评分〈3分老年患者围手术期及长期随访安全有效：对mRS评分≥3分老年患者围手术期内脑卒中发生率高．但长期随访显示对再发脑卒中有预防作用。
Objective To analyze the therapeutic effect of carotid endarterectomy （CEA） in elderly patients （〉70 years old） with carotid stenosis and neurological deficits. Methods One hundred and twenty-six elderly patients underwent CEA from May 2008 to April 2015, including 7 patients accepted bilateral operation, were chosen in our study. A total of 133 operations were performed in these patients. According to the preoperative modified Rankin scale （mRs） scores, they were divided into a mrs〈3 group （n=107）, and a mRs〉 3 group （n=26）. Follow up for 9-18 months, averaged 12.3 months,was performed. Clinical data of these patients were retrospectively analyzed, and operation safety and surgical efficacy were compared between the two groups. Results （1） All operations were successful; the incidence of cerebral apoplexy within 30 d after procedure in the mrs≥ 3 group was significantly higher than that in the mRs〈3 group. （2） The diameter of the internal carotid artery stenosis one month after operation was increased as compared with that before operation, peak systolic velocity and end diastolic velocity were improved by Color Doppler Ultrasound in the two groups of patients; but there were no statistically significant differences between the two groups （P〉0.05）. （3） During long-term follow-up, 4 occurred restenosis in the mRs〈3 group, only one had transient ischemic attack, and 2 patients died of other reasons during follow-up; one occurred restenosis in the mRs ≥ 3 group; there were no statistically significant differences in restenosis and transient ischemic attack rates between the two groups （P〉0.05）. Conclusion CEA is a safe and effective treatment for the elderly patients with mrs 〈3; the incidence rate of cerebral apoplexy is high during the perioperative period in mRS≥ 3 patients, however, long-term follow-up shows that it can prevent recurrent stroke.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2016年第12期1224-1230,共7页
Chinese Journal of Neuromedicine
基金
（1）基金项目：国家“十二五”科技支撑计划项目（2011BA108804）（2）基金项目：山东省科技惠民计划项目（2014kjhm0109）
