颈动脉内膜剥脱患者围手术期急性冠脉综合征的诊断与治疗

Diagnosis and treatment of acute coronary syndromes after carotid endarterectomy

目的 探讨颈动脉内膜剥脱术围手术期急性冠脉综合征的发生率、诊断与治疗策略.方法 回顾性分析2003--2009年北京协和医院血管外科收治的143例重度动脉硬化性颈动脉狭窄患者,共施行159例次颈动脉内膜剥脱术围手术期发生急性冠脉综合征的相关临床资料.结果 年龄40～86岁,平均（66±9）岁.术后30d内出现脑卒中5例（3.1%）,有症状颈动脉狭窄组术后30 d卒中/死亡4例（3.6%）,无症状颈动脉狭窄组1例（2.1%）.13例（8.2%）围手术期发生急性冠脉综合征,12例经药物治疗缓解,1例行冠脉球囊扩张并植入支架后康复,无1例死亡.糖尿病史（RR=7.727,P=0.001）、吸烟史（RR=8.138,P=0.020）和既往心梗病史（RR=4.567,P=0.027）是颈动脉内膜剥脱术围手术期发生急性冠脉综合征的显著危险因素.结论 急性冠脉综合征是颈动脉内膜剥脱术围手术期重要的非神经系统并发症,糖尿病史、吸烟史和既往心梗病史是发生急性冠脉综合征的显著危险因素,综合运用多种策略预防治疗急性冠脉综合征对增加颈动脉内膜剥脱术的安全性具有重要意义.

Objective To summarize the incidence,diagnosis and treatment of acute coronary syndrome（ACS） after carotid endarterectomy（CEA）.Methods From 2003 to 2009,159 CEA were performed in 143 cases with severe atherosclerotic carotid artery stenosis.The clinical datas of ACS after CEA were collected.Results The average age was 66.2±9.0 years old,varying from 40 to 86.There were 5 cases（3.1%）suffered from 30-day perioperative stroke/death totally,of which 4 cases （3.6%）in the symptomatic carotid stenosis group and 1 case（2.1%）in the asymptomatic group.13 cases（8.2%） were diagnosed as ACS after CEA,12 of them recovered after medicine,but one case aggravated even after the conservative treatment.Percutaneous coronary angioplasty and stenting was performed then.All cases were cured without death.Diabetes mellitus（RR=7.727,P=0.001）,smoking（RR=8.138,P=0.020） and cardiac infarction history（RR=8.138,P=0.020）are significant risk factors for ACS after CEA. Conclusions ACS is an important non-neurological complication after CEA.Diabetes melltus,smoking and cardiac infarction history are significant risk factors for ACS after CEA Early diagnosis and appropriate medical intervention for ACS can improve the safety of CEA.