不同颈动脉手术方法对于冠心病合并重度颈动脉狭窄患者行冠状动脉旁路移植术早期预后影响的对比研究

Comparative Study on the Early Results of Patients with Coronary Artery Disease Complicated with Severe Carotid Artery Stenosis undergoing Different Carotid Artery Surgery and Coronary Artery Bypass Grafting

目的评价颈动脉内膜剥脱术(Carotid Endarterectomy,CEA)或颈动脉支架植入术(Carotid Artery Stent,CAS)对于冠心病合并无症状重度颈动脉狭窄患者同期接受冠状动脉旁路移植术(Coronary Artery Bypass Graft,CABG)早期预后的影响。方法本研究包括中国阜外医院于2005年12月-2014年12月60名合并无症状重度颈动脉狭窄的冠心病患者。其中,组1为27名患者接受单侧CAS后同期接受非体外循环下CABG,组2为33名患者接受单侧CEA后同期接受非体外循环下CABG。记录并分析患者主要的心脑血管不良事件和死亡的发生率。结果 CAS-CABG组患者术后心脑血管不良事件(MACCE)和死亡的发生率分别为14.81%和0%,CEA-CABG组患者术后MACCE和死亡的发生率均为3.03%,两组患者间术后MACCE事件和死亡的发生率无统计学差异(p>0.05)。与CEA-CABG组比较,CAS-CABG组术后24h胸液引流量显著增多,差异有统计学意义(p<0.05)。与CEA-CABG组比较,CASCABG组术后住院时间显著缩短,差异有统计学意义(p<0.05)。结论同期单侧CAS和非体外循环下CABG与同期单侧CEA和非体外循环下CABG对于冠心病合并重度无症状颈动脉狭窄患者的近期疗效均满意。同期单侧CAS和非体外循环下CABG较同期单侧CEA和非体外循环下CABG术后住院时间缩短。

Objective To evaluate the early results of simultaneous carotid endarterectomy （CEA） or carotid artery stent（CAS） and coronary artery bypass grafting （CABG） in patients with asymptomatic severe carotid artery stenosis and coronary heart disease. Methods An observational study was performed on 60 patients with asymptomatic severe carotid artery stenosis and coronary heart disease in Fuwai hospital during December, 2005 to December, 2014. They were divided into two group： 27 patients received simultaneous unilateral CAS and off-pump CABG, 33 patients received simultaneous unilateral CEA and off-pump CABG. The patient,s major adverse cerebral and cardiovascular events and death were recorded and analyzed. Results The incidence of MACCE and death in CAS-CABG group was 14.81% and 0%, respectively. The incidence of MACCE and death in CEA-CABG group was both 3.03%. There were no significant differences in the incidence of MACCE and death between the two groups（p〉0.05）.Compared with CEA-CABG group, the patients in CAS-CABG group were associated with significant increased post-operative 24 hour chest tube drainage（P〈0.05）. Compared with CEA-CABG group, the patients in CAS-CABG group were associated with significant decreased post-operative hospital stay（p〈0.05）. Conclusion The early outcome of simultaneous unilateral CEA or CAS and CABG to the patients with asymptomatic severe carotid artery stenosis and coronary heart disease is satisfactory. The patients received simultaneous unilateral CAS and off-pump CABG are associated with significant decreased post-operative hospital stay.