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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
刘端,李梓伦,王冕,武日东,王劲松,王深明,姚陈,常光其.颈动脉内膜剥脱术中选择性转流的初步研究[J].中华老年多器官疾病杂志,2020,19(1):25~29
颈动脉内膜剥脱术中选择性转流的初步研究
Preliminary study of selective shunting in carotid endarterectomy
投稿时间:2019-10-09  
DOI:10.11915/j.issn.1671-5403.2020.01.006
中文关键词:  颈动脉内膜剥脱;转流管;颈动脉;反流压;脑电图
英文关键词:carotid endarterectomy; shunt; carotid artery; stump pressure; electroencephalography This work was supported by Science and Technology Project of Guangzhou
基金项目:广州市科技计划项目(201508020116,201710010056)
作者单位E-mail
刘端 中山大学附属第一医院血管外科,广州 510080 13922231628@163.compreliminary 
李梓伦 中山大学附属第一医院血管外科,广州 510080 13922231628@163.compreliminary 
王冕 中山大学附属第一医院血管外科,广州 510080 13922231628@163.compreliminary 
武日东 中山大学附属第一医院血管外科,广州 510080 13922231628@163.compreliminary 
王劲松 中山大学附属第一医院血管外科,广州 510080 13922231628@163.compreliminary 
王深明 中山大学附属第一医院血管外科,广州 510080 13922231628@163.compreliminary 
姚陈 中山大学附属第一医院血管外科,广州 510080 13922231628@163.compreliminary 
常光其 中山大学附属第一医院血管外科,广州 510080 13922231628@163.compreliminary 
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中文摘要:
      目的 评估全身麻醉下颈动脉内膜剥脱术(CEA)中选择性转流的中远期效果。方法 回顾性分析2013年3月至2019年6月中山大学附属第一医院血管外科接受CEA术患者129例,根据术中是否应用转流管分为转流组48例和非转流组81例。术后3个月行头颈部彩超检查,之后每6个月至1年常规随访1次,比较2组患者中远期总体生存率和无再狭窄生存率。 应用SPSS 20.0统计软件对数据进行分析。依据数据类型采用t检验或χ2检验进行组间比较。Kaplan-Meier分析总体存活率和无再狭窄存活率。结果 转流组相比非转流组伴对侧颈动脉闭塞比例高[29.2%(14/48)和3.7%(3/81)],差异具有统计学意义(P<0.001)。转流组相比非转流组颈动脉夹闭时间[(22.6±5.9)和(13.7±4.6)min]和手术时间[(168.4±63.3)和(143.0±50.2)min]长,术中出血量多[(108.0±65.2)和(69.8±53.9)ml],住院时间短[(5.5±1.4)和(6.1±1.7)d],术中应用补片比例高[60.4%(21/48)和25.9%(29/81)],差异均具有统计学意义(P<0.05)。术后6周2组均无患者死亡,转流组相比非转流组脑卒中[2.1%(1/48)和1.2%(1/81)]和同侧颈动脉再狭窄[4.2%(2/48)和1.2%(1/81)]差异无统计学意义(χ2=0.142,P=0.706;χ2=1.141,P=0.285)。Kaplan-Meier分析结果表明2组患者中远期总体生存率(χ2=0.287,P=0.592)和无再狭窄生存率(χ2=0.285,P=0.593)差异均无统计学意义(P>0.05)。结论 CEA术中选择性不使用转流管对中远期生存率和无再狭窄生存率无影响。
英文摘要:
      Objective To evaluate mid- and long-term effect of selective shunting in carotid endarterectomy (CEA) under general anesthesia. Methods A retrospective analysis was made of 129 patients who received CEA in Department of Vascular Surgery of the First Affiliated Hospital of Sun Yatsen University from March 2013 to June 2019. They were divided into shunting group (n=48) and non-shunting group (n=81). Color Doppler ultrasound was performed for the head and neck at 3 months after operation. The patients received a follow-up visit once every 6 months to 1 year. The two groups were compared in the overall survival rate and restenosis-free survival rate. SPSS statistics 20.0 was used to analyze the data. Depending on data type, t test or χ2 test was used to compare the two groups. Kaplan-Meier was used to analyze overall survival and restenosis-free survival rate. Results The shunting group had a higher occlusive rate of contralateral carotid artery than the non-shunting group [29.2%(14/48) vs 3.7%(3/81)], the difference being statistically significant (P<0.001). Compared with the non-shunting group, the shunting group had longer clamping time [(22.6±5.9) vs (13.7±4.6)min] and operation time [(168.4±63.3) vs (143.0±50.2)min], more intraoperative bleeding [(108.0±65.2) vs (69.8±53.9)ml], shorter length of hospital stay [(5.5±1.4) vs (6.1±1.7)d], higher usage of patch [60.4%(21/48) vs 25.9%(29/81)], all the differences having statistical significance (P<0.05 for all). No death occurred in both groups at 6 weeks after operation. There was no significant difference in stroke [2.1%(1/48) vs 1.2%(1/81)] and carotid restenosis [(4.2%(2/48) vs 1.2%(1/81)] between the two groups (χ2=0.142, P=0.706; χ2=1.141, P=0.285). Kaplan-Meier analysis showed no significant difference in the overall survival rate (χ2= 0.287, P=0.592) and restenosis-free survival rate (χ2=0.285,P=0.593) between the two groups (P>0.05). Conclusion The selective use of carotid artery shunt in CEA has no effect on the long-term survival rate and restenosis-free survival rate .
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