颈动脉内膜切除术治疗颈动脉狭窄后不同神经功能缺损患者的安全性分析

目的分析颈动脉狭窄后神经功能缺损患者接受颈动脉内膜切除术（CEA）治疗的安全性。方法回顾性分析首都医科大学宣武医院441例接受CEA治疗的颈动脉狭窄患者的临床资料，根据术前改良Rankin量表（mRS）评分，分为mRS〈3分组（409例）和mRS≥3分组（32例），分析两组在危险因素方面的特征，比较两组手术的安全性和随访结果。结果①mRS≥3分组术后30d内的脑梗死、脑出血、死亡的发生率高于mRS〈3分组，但两组仅脑梗死发生率的差异有统计学意义，P〈0．01。②术后30d共随访430例患者，mRS〈3分组随访401例，mRS≥3分组29例，两组患者均未出现再狭窄、TIA和卒中。③术后1年，共随访286例患者，mRS〈3分组262例患者中，10例出现再狭窄，2例出现TIA；mRS≥3分组24例患者无再狭窄发生，未发生缺血事件。结论mRS≥3分患者行CEA治疗时术后脑梗死发生率高于mRS〈3分组。长期随访的再狭窄和缺血事件差异无统计学意义。

Safety analysis of carotid endarterectomy in patients with different neurological deficits

Objective To analyze the safety of carotid endarterectomy （CEA） in patients with caro tid stenosis and neurological deficits. Methods The clinical data of 441 patients with carotid stenosis un- derwent CEA at Xuanwu Hospital of Capital Medical University were analyzed retrospectively. According to the preoperative modified Rankin scale （mRS） scores, they were divided into a mRS 〈 3 group （ n = 409） and a mRS≥3 group （n =32）. The clinical characters of risk factors were analyzed and the safety of sur- gery and the long-term follow-up resuhs were compared between the two groups. Results ①Tbe inci- dences of cerebral infarction, cerebral hemorrhage, and death within 30 days after procedure in the mRS ≥3 group were higher than those in the mRS 〈 3 group, but there was only statistically significant in the inci- dence of cerebral infarction. ②A total of 430 patients （401 in the mRS 〈 3 group and 29 in the mRS ≥3 group） were followed up at 30 days after procedure. No restenosis, TIA and stroke occurred in both groups. ③A total of 286 patients were followed up at 1 year after procedure, Of the 262 patients in the mRS 〈 3 group, 10 occurred restenosis, only 2 had TIA; 24 patients in the mRS ≥ 3 group no restenosis and ischemic events occurred. Conclusion The incidence of cerebral infarction after CEA in the mRS≥3 group pa- tients was higher than those of the mRS 〈 3 group. There is no significant difference between the 2 groups in the restenosis and ischemic events after long-term follow up study.