颈动脉内膜剥脱术围手术期脑血管事件分析

Analysis of perioperative cerebrovascular events after carotid endarteretomy

目的分析颈动脉内膜剥脱术(CEA)的病例数据,获得围手术期脑血管事件的特点和风险因素。方法回顾性分析北京天坛医院2012年1月至2015年4月所做的209例CEA手术患者的资料,分析患者临床特征和围手术期脑血管事件的特点,对相关危险因素进行单因素χ2检验并计算其优势比(OR)。结果男性多于女性患者(177∶32),脑梗死是最多的临床表现(68.42%),高血压是最多的合并症(68.42%)。围手术期出现高灌注者9例、卒中5例,其中脑出血3例。高灌注患者合并高脂血症比例高(8/9),脑出血患者合并慢性阻塞性肺疾病和慢性肾功能不全的比例高(2/3),单因素分析显示:高脂血症是围手术期脑血管事件的危险因素(OR=3.861,P=0.029),合并高脂血症是围手术期高灌注的危险因素(OR=17.397,P=0.001)、患者存在慢性阻塞性肺疾病是围手术期卒中发生的危险因素(OR=33.333,P=0.007),也是围手术期脑出血发生的危险因素(OR=101.000,P=0.002),合并慢性肾功能不全是围手术期脑出血的危险因素(OR=51.000,P=0.043)。结论CEA围手术期高灌注是出现最多的脑血管事件,脑出血是最严重的脑血管事件,高脂血症增加了患者围手术期高灌注风险,慢性阻塞性肺疾病和慢性肾功能不全患者有更高的围手术期脑出血风险。

Objective Case data of carotid endarterectomy(CEA)were analyzed to obtain the characteristics of perioperative cerebrovascular events and associated risk factor.Methods We retrospected 209 cases of CEA in Beijing Tiantan Hospital from January 2012 to April 2015,and analyzed the clinical characteristics.Relevant factors of perioperative cerebrovascular events were tested byχ2 and the odds ratio(OR)was calculated.Results There were more males than females(177∶32).Cerebal infarction was the most common clinical manifestation(68.42%).Hypertension was the most common comorbidity(68.42%).There were 9 cases with hyperperfusion,3 cases with cerebral hemorrhage in 5 cases with stroke during perioperative period.The proportion of hyperlipidemia in patients with hyperperfusion(8/9),chronic obstructive pulmonary disease(COPD)and chronic renal insufficiency(CRI)in patients with cerebral hemorrhage(2/3)were high.Univariate analysis byχ2 test showed that hyperlipidemia was a risk factor for perioperative cerebrovascular events(OR=3.861,P=0.029).Besides concomitant hyperlipidemia was a risk factor for perioperative hyperperfusion(OR=17.397,P=0.001).The presence of chronic obstructive pulmonary disease in patients was a risk factor for perioperative stroke(OR=33.333,P=0.007),and also a risk factor for perioperative intracerebral hemorrhage(OR=101.000,P=0.002).,Chronic renal insufficiency was a risk factor for perioperative intracerebral hemorrhage(OR=51.000,P=0.043).Conclusion Hyperperfusion was the most common cerebrovascular events during perioperative period of CEA,and cerebral hemorrhage was the most serious cerebrovascular events.Hyperlipidemia increased the risk of hyperperfusion.Patients with COPD and CRI had a higher risk of perioperative cerebral hemorrhage.