中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2014年
6期
448-451
,共4页
刁永鹏%刘昌伟%宋小军%李拥军%陈跃鑫%郭李龙%郑月宏%叶炜%刘暴
刁永鵬%劉昌偉%宋小軍%李擁軍%陳躍鑫%郭李龍%鄭月宏%葉煒%劉暴
조영붕%류창위%송소군%리옹군%진약흠%곽리룡%정월굉%협위%류폭
颈动脉狭窄%颈动脉内膜切除术%手术后并发症%危险因素
頸動脈狹窄%頸動脈內膜切除術%手術後併髮癥%危險因素
경동맥협착%경동맥내막절제술%수술후병발증%위험인소
Carotid stenosis%Endarterectomy,carotid%Postoperative complications%Risk factors
目的 分析颈动脉内膜剥脱术(carotid endarterectomy,CEA)治疗老年(≥65岁)颅外段颈动脉狭窄患者的相关危险因素.方法 回顾性分析北京协和医院2009年10月至2012年10月行CEA治疗的312例颈动脉狭窄患者资料,采用单因素及多因素Logistic回归分析,分析影响老年患者手术并发症和预后的相关危险因素.结果 共纳入145例患者,平均随访时间(22±9)个月.其中男116例,女29例,平均年龄(72±4)岁,双侧病变患者51例,无症状患者41例,共施行158例次CEA,105例采用人工血管补片,69例术中使用转流管,平均住院时间(17±5)d.多因素Logistic分析显示:颈动脉阻断时间(OR=0.926,95％ CI:0.875～0.981)、冠心病(OR =5.117,95％ CI:1.197 ～21.866)和外周血管病(OR =4.801,95％ CI:1.121 ～ 20.564)是手术并发症的独立危险因素;高同型半胱氨酸血症(OR=6.452,95％ CI:1.140 ～ 36.519)是术后再狭窄和脑梗死的独立危险因素.结论 颈动脉阻断时间长、合并冠心病和外周血管病增加老年颈动脉狭窄患者的CEA手术风险,高同型半胱氨酸血症是CEA术后再狭窄和脑梗死的危险因素.
目的 分析頸動脈內膜剝脫術(carotid endarterectomy,CEA)治療老年(≥65歲)顱外段頸動脈狹窄患者的相關危險因素.方法 迴顧性分析北京協和醫院2009年10月至2012年10月行CEA治療的312例頸動脈狹窄患者資料,採用單因素及多因素Logistic迴歸分析,分析影響老年患者手術併髮癥和預後的相關危險因素.結果 共納入145例患者,平均隨訪時間(22±9)箇月.其中男116例,女29例,平均年齡(72±4)歲,雙側病變患者51例,無癥狀患者41例,共施行158例次CEA,105例採用人工血管補片,69例術中使用轉流管,平均住院時間(17±5)d.多因素Logistic分析顯示:頸動脈阻斷時間(OR=0.926,95％ CI:0.875～0.981)、冠心病(OR =5.117,95％ CI:1.197 ～21.866)和外週血管病(OR =4.801,95％ CI:1.121 ～ 20.564)是手術併髮癥的獨立危險因素;高同型半胱氨痠血癥(OR=6.452,95％ CI:1.140 ～ 36.519)是術後再狹窄和腦梗死的獨立危險因素.結論 頸動脈阻斷時間長、閤併冠心病和外週血管病增加老年頸動脈狹窄患者的CEA手術風險,高同型半胱氨痠血癥是CEA術後再狹窄和腦梗死的危險因素.
목적 분석경동맥내막박탈술(carotid endarterectomy,CEA)치료노년(≥65세)로외단경동맥협착환자적상관위험인소.방법 회고성분석북경협화의원2009년10월지2012년10월행CEA치료적312례경동맥협착환자자료,채용단인소급다인소Logistic회귀분석,분석영향노년환자수술병발증화예후적상관위험인소.결과 공납입145례환자,평균수방시간(22±9)개월.기중남116례,녀29례,평균년령(72±4)세,쌍측병변환자51례,무증상환자41례,공시행158례차CEA,105례채용인공혈관보편,69례술중사용전류관,평균주원시간(17±5)d.다인소Logistic분석현시:경동맥조단시간(OR=0.926,95％ CI:0.875～0.981)、관심병(OR =5.117,95％ CI:1.197 ～21.866)화외주혈관병(OR =4.801,95％ CI:1.121 ～ 20.564)시수술병발증적독립위험인소;고동형반광안산혈증(OR=6.452,95％ CI:1.140 ～ 36.519)시술후재협착화뇌경사적독립위험인소.결론 경동맥조단시간장、합병관심병화외주혈관병증가노년경동맥협착환자적CEA수술풍험,고동형반광안산혈증시CEA술후재협착화뇌경사적위험인소.
Objective To analyze the risk factors for carotid endarterectomy (CEA) in elder patients of carotid artery stenosis(CAS).Methods Clinical data of 312 CAS cases undergoing CEA from Oct 2009 to Oct 2012 were analyzed.The univariate and multivariate Logistic regression analyses were used to analyze the risk factors predicting the complications and prognosis of CEA.Results One hundred fortyfive cases were brought into the research.The mean follow-up was (22 ±9) months.There were 116 males and 29 females.The mean age was (72 ±4) years.Fifty-one cases were with bilateral lesions,and 41 cases were asymptomatic.A total of 158 CEA procedures were successfully performed.One hundred and five artificial vascular patches and 69 shunts were used.The mean hospital stay was (17 ± 5) days.Multivariate Logistic regression showed carotid artery clamping time(OR =0.926,95％ CI:0.875-0.981),coronary atherosclerotic heart disease(OR =5.117,95％ CI:1.197-21.866) and peripheral arterial disease (OR =4.801,95％ CI:1.121-20.564 were the independent risk factors for surgical complications,and hyperhomocysteinemia (OR =6.452,95％ CI:1.140-36.519) was the independent risk factor for restenosis and stroke after CEA.Conclusions The clamping time of carotid artery,coronary atherosclerotic heart disease and peripheral arterial disease increase the risk of CEA in the elders.Hyperhomocysteinemia was the independent risk factor for restenosis and stroke after CEA.
