颈动脉内膜切除术对心脏功能的影响

Effect of carotid endarterectomy on cardiac function

目的探讨颈动脉内膜切除术对于心脏功能的影响，以降低术后心脏方面并发症的发生。方法回顾性分析广西医科大学第四附属医院神经外科2012年1月至2013年6月行颈动脉内膜切除术的50例颈动脉狭窄患者的术前心脏功能检查、术后24h内血压及心率的变化。结果50例患者中7例有明确的冠心病病史，18例常规心电图报告窦性心动过缓和（或）心肌部分缺血改变，41例超声心动报告左室舒张功能轻度减低。术后13例出现不同程度的心率及血压下降，且9例为术前检查心脏功能出现问题的患者，13例患者中2例出现急性冠状动脉综合征，住院期间未再出现明显的临床症状，患者均好转出院。1例患者出现广泛前壁心肌梗死，经积极抢救后无效死亡。结论颈动脉内膜切除术对于心脏功能的影响较大，加强术前对心脏功能的检查、减少术中对颈动脉鞘的损伤、积极处理术后心率以及血压的变化，对于降低患者的致残、致死率至关重要。

Objective To investigate the effect of carotid endarterectomy on cardiac function in order to reduce the occurrence of cardiac complications after procedure. Methods The preoperative cardiac function tests, blood pressure within 24 h after procedure, and changes in heart rate in 50 patients with carotid steuosis treated with carotid endarterectomy at the Department of Neurosurgery, the Fourth Affiliated Hospital of Guangxi Medical University from January 2012 to June 2013 were analyzed retrospectively. Results In 50 patients, 7 had a definite history of coronary heart disease. Routine electrocardiogram reported 18 had sinus bradycardia and/or some changes in myocardial ischemia, and echocardiography reported 41 had a mildly reduced left ventricular diastolic function. After procedure, 13 patients had decreased heart rate and blood pressure in different degrees, and 9 had cardiac function problems before procedure. Two of the 13 patients had acute coronary syndrome. They did not have any obvious clinical symptoms during hospitalization. They all improved and discharged from the hospital. One patient had extensive anterior myocardial infarction, and he died after active rescue. Conclusions Carotid endarteretomy has a greater impact on cardiac function. Strengthening the preoperative heart function examination, reducing intraoperatie injury of carotid sheath, actively managing the changes of postoperative heart rate, and blood pressure are critical for decreasing the disability and mortality.