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目的分析颈动脉狭窄后神经功能缺损患者接受颈动脉内膜切除术(CEA)治疗的安全性。方法回顾性分析首都医科大学宣武医院441例接受CEA治疗的颈动脉狭窄患者的临床资料,根据术前改良Rankin量表(mRS)评分,分为mRS<3分组(409例)和mRS≥3分组(32例),分析两组在危险因素方面的特征,比较两组手术的安全性和随访结果。结果①mRS≥3分组术后30 d内的脑梗死、脑出血、死亡的发生率高于mRS<3分组,但两组仅脑梗死发生率的差异有统计学意义,P<0.01。②术后30 d共随访430例患者,mRS<3分组随访401例,mRS≥3分组29例,两组患者均未出现再狭窄、TIA和卒中。③术后1年,共随访286例患者,mRS<3分组262例患者中,10例出现再狭窄,2例出现TIA;mRS≥3分组24例患者无再狭窄发生,未发生缺血事件。结论 mRS≥3分患者行CEA治疗时术后脑梗死发生率高于mRS<3分组。长期随访的再狭窄和缺血事件差异无统计学意义。
Objective To analyze the safety of carotid endarterectomy (CEA) in patients with neurological deficits after carotid artery stenosis. Methods The clinical data of 441 patients with carotid stenosis treated with CEA at Xuanwu Hospital of Capital Medical University were retrospectively analyzed. According to the preoperative modified Rankin Scale (mRS), the patients were divided into mRS <3 group (409 cases) and mRS≥3 group (32 cases). The characteristics of the two groups in risk factors were analyzed. The safety and follow-up results of the two groups were compared. Results ① The incidence of cerebral infarction, cerebral hemorrhage and death within 30 days after operation in mRS≥3 group was higher than that in mRS <3 group, but there was significant difference between the two groups only (P <0.01). ② A total of 430 patients were followed up 30 days after operation. There were 401 patients with mRS <3 and 29 patients with mRS≥3. No restenosis, TIA and stroke were found in either group. ③ One year after operation, a total of 286 patients were followed up. Among the 262 patients with mRS <3, there were 10 patients with restenosis and 2 patients with TIA. There were no restenosis in 24 patients with mRS≥3, and no ischemic events occurred. Conclusion The incidence of postoperative cerebral infarction in patients with mRS≥3 was higher than that in patients with mRS <3 when CEA was performed. Long-term follow-up of restenosis and ischemic events showed no significant difference.