颈动脉内膜剥脱联合颈动脉转流术治疗高龄颈动脉狭窄的临床观察

Observation on carotid endarterectomy combined with carotid artery shunting on elderly patients with carotid stenosis

目的分析高龄颈动脉狭窄患者采用颈动脉内膜剥脱术联合颈动脉转流术治疗的效果及安全性。方法抽取2016年10月至2019年10月于平顶山市第二人民医院神经外科就诊的86例老年颈动脉狭窄患者,使用随机双盲法将其分为对照组(41例)与研究组(45例)。研究组采用颈动脉内膜剥脱术联合颈动脉转流术,对照组使用颈动脉内膜剥脱术。观察两组术中阻断血流时间,术后随访12个月,观察两组主要终点事件。分析颈动脉内膜剥脱术中应用转流管对术中脑缺血时间、术后并发症发生率及病死率的影响。结果所有患者术后影像学检查均提示颈动脉通畅。研究组阻断血流时间为(4.0±1.0)min,短于对照组的(10.0±3.0)min,差异有统计学意义(P<0.01)。研究组出现脑过度灌注综合征1例(2.22%),对照组出现小面积脑梗死3例(7.32%);术后1年复查两组均出现颈动脉再狭窄1例(2.22%)。两组患者术后不良反应发生率比较差异未见统计学意义(P>0.05)。结论针对颈动脉狭窄老年患者,采用颈动脉内膜剥脱联合颈动脉转流术可缩短术中脑缺血时间,对脑组织起到强有力的保护作用。

Objective To analyze the efficacy and safety of carotid endarterectomy combined with carotid artery shunting for elderly patients with carotid stenosis.Methods The clinical data from 86 patients with carotid stenosis treated in the Second People’s Hospital of Pingdingshan from October 2016 to October 2019 were selected,and they were divided into control group(41 cases)and study group(45 cases)by double blind method.The control group was treated by carotid endarterectomy,and the study group was treated by carotid endarterectomy combined with carotid artery shunting.The intraoperative blood flow blocking time of the two groups was observed.All patients were followed up for 12 months,and the main endpoint events of the two groups were observed.And effects of carotid endarterectomy on brain ischemia time,incidence of complication and case fatality rate were analyzed.Results Imagine study of all patients showed carotid artery open.The blood flow blocking time of the study group was(4.0±1.0)min,significantly shorter than the(10.0±3.0)min of the control group(P<0.01).There was a cases of cerebral hyperperfusion syndrome(2.22%)in the study group,and 3 cases(7.32%)in the postoperative operation.Both groups had one case(2.22%)carotid artery re-stenosis according to recheck 1 year after operation.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Carotid endarterectomy combined with carotid artery shunting can shorten the time of cerebral ischemia,so as to protect the brain issue effectively.