颈动脉内膜剥脱术治疗颈动脉狭窄的疗效与危险因素分析

The analysis of risk factors and outcomes of carotid endarterectomy for carotid artery stenosis

目的评价颈动脉内膜剥脱术治疗颈动脉狭窄的早期和中远期结局，分析不良结局的危险因素。方法回顾性分析2006年10月至2012年11月北京协和医院血管外科采用颈动脉内膜剥脱术治疗颈动脉狭窄的369例患者的临床资料。记录患者的一般情况、围手术期及随访资料。结果369例患者共实行了407次颈动脉内膜剥脱术。术后中远期（≥30d）随访率为89．9％，随访时间为11．8-48．3个月，其中症状性颈动脉狭窄、狭窄程度270％、对侧颈动脉重度狭窄的比例分别为78．0％（317／407）、98．4％（400／407）和12．0％（49／407）。术后早期（〈30d）卒中、心脏事件、死亡总发生率为3．9％（16／407），且各个危险因素对术后30d结局的影响差异均无统计学意义（均P〉0．05）。而中远期卒中、心脏事件、死亡总发生率为8．7％（32／366），单因素分析显示吸烟者中远期总并发症发生率高于非吸烟者（12．1％比5．1％，P〈0．05）；对侧颈动脉狭窄者高于非狭窄者（28．6％比8．0％，P〈0．05）。而logistic多因素回归分析显示：年龄≥65岁、吸烟、心肌梗死史、对侧颈动脉狭窄术后发生中远期不良结局的风险比（HR）分别为2．59、2．66、2．48、6．06。结论颈动脉内膜剥脱术是安全治疗颈动脉狭窄的手术方式之一；而年龄≥65岁、吸烟史、对侧颈动脉狭窄和心肌梗死史是颈动脉内膜剥脱术后发生中远期不良结局的危险因素。

Objective To evaluate the early and long-term outcomes of carotid endarterectomy for carotid artery stenosis and analyse the risk factors for the outcomes. Methods A retrospective review of 369 patients underwent carotid endarterectomy（CEA） in Peking Union Medical College Hospital from Oct 2006 to Nov 2012 was conducted. Clinical data including general conditions, perioperative and follow-up outcomes were collected. Results Three hundred sixty-nine patients underwent 407 CEAs. The long-term follow-up rate （ ≥30 d） was 89. 9% and follow-up period was 11.8 -48.3 months. Among 407 CEAs, patients with symptomatic carotid artery stenosis, carotid stenosis over 70% and contralateral severe carotid stenosis occupied 78. 0% （ 317/407 ）, 98.4% （ 400/407 ） and 12. 04% （ 49/407 ） respectively. Total early complications （ 〈30 d） of stroke, cardiac events and death was 3.93% （16/407）. Univariate analysis showed no risk factor had significant effect on early complications （P 〉 0.05）. Total long-term complications of stroke, cardiac events and death was 8. 7% （32/366）. Univariate analysis showed that total long-term complication rate of smoking group was higher than non-smoking group （ 12. 1% vs 5.1% , P 〈 0. 05 ）, contralateral carotid artery stenosis group was higher than opposite one （28.6% vs 8.0%, P 〈 0. 05 ）. Multivariate Logistic regression showed the HR of long-term complications rate in patients aged over 65 years, smoking history, myocardial infarction and contralateral carotid stenosis were 2.59,2. 66, 2. 48 and 6. 06, respectively. Conclusions CEA is safe method for the treatment of carotid stenosis. To CEA, age over 65 years, smoking history, myocardial infarction and contralateral carotid stenosis are risk factors for long-term adverse outcomes.