颈动脉内膜剥脱术与支架置入术治疗颈动脉粥样硬化狭窄疗效对比

目的比较颈动脉粥样硬化狭窄采取颈动脉内膜剥脱术与支架置入术治疗的临床效果。方法选取2015年1月—2016年2月自愿参与本次研究的颈动脉粥样硬化狭窄患者94例,随机分为对照组和观察组各46例,对照组行颈动脉支架置入术治疗,观察组行颈动脉内膜剥脱术治疗,比较两组手术效果及并发症发生情况,数据采用SPSS19.0软件进行统计学处理。结果观察组总有效率为95.74%高于对照组的78.72%(χ~2=13.001,P0.05),观察组术后并发症发生率为10.64%低于对照组的23.40%,两组比较差异有统计学意义(χ~2=5.764,P0.05)。结论对颈动脉粥样硬化狭窄患者采取颈动脉内膜剥脱术治疗的疗效较好,改善患者临床症状,且用药安全,值得推广。     

颈动脉内膜剥脱术与支架置入术治疗颈动脉狭窄的卫生经济学评价

目的：评价颈动脉内膜剥脱术和颈动脉支架置入术治疗颈动脉狭窄患者的经济学价值，为临床决策提供参考。 方法：通过专家访谈，确认两种术式的标准流程，进而计算出两种术式的直接医疗成本。通过系统综述的方式确定各个效果指标的初始值和范围。由此构建出决策树模型，对两种术式进行成本-效果分析和概率敏感性分析。结果：在各个指标上， 颈动脉内膜剥脱术的成本效果比均低于颈动脉支架置入术。敏感性分析结果显示，在手术后脑卒中发生率、短暂性脑缺血发生率、再狭窄发生率和高灌注综合征发生率上，颈动脉内膜剥脱术比颈动脉支架置入术占绝对优势的概率均大于85%。在手术后局部血肿、脑出血和心肌梗死发生率上，颈动脉内膜剥脱术比颈动脉支架置入术并没有绝对优势。结论：颈动脉内膜剥脱术相比颈动脉支架置入术有较好的经济性，建议临床医生在充分考虑患者的实际病情下，使用颈动脉内膜剥脱术进行治疗。此外，应采取相关行动，积极推广颈动脉内膜剥脱术，提高颈动脉狭窄患者的生命质量，改善健康状况。     

颈动脉支架植入术联合纽曼系统护理在症状性颈动脉狭窄患者治疗中的应用研究

目的 探讨颈动脉支架植入术联合纽曼系统护理在症状性颈动脉狭窄患者治疗中的应用效果,以及对患者生活质量、认知功能的影响为临床治疗干预提供参考。方法 选取江门市人民医院2019年7月至2022年7月收治的症状性颈动脉狭窄患者42例,以随机数字表法分为对照组（21例,颈动脉内膜剥脱术治疗）、观察组（21例,颈动脉支架植入术治疗）,两组均接受纽曼系统护理干预,并于术后随访12个月。观察比较两组患者围手术期指标,术前及术后1周肽素（Copeptin）、心型脂肪酸结合蛋白（H-FABP）、白细胞介素-10(IL-10)、白细胞介素-6(IL-6)水平,术前及术后12个月简明健康状况量表（SF-36）评分、日常生活活动量表（ADL）评分、简易智能状态检查量表（MMSE）评分,以及术后随访期间不良事件发生情况。结果 两组患者手术时间、手术成功率及随访期间不良事件总发生率相比,差异均无统计学意义（均P>0.05）;观察组患者住院时间短于对照组;与术前比,术后1周两组患者血清Copeptin、H-FABP水平均降低,血清IL-10、IL-6水平均升高,观察组均较对照组更低;与术前比,术后12个月两组...     

双侧颈动脉狭窄支架置人术的护理体会

目的总结双侧颈动脉狭窄行支架置入术患者的护理体会。方法笔者所在科于2009年3月以来施行的颈动脉球囊扩张支架置入术患者10例,采用经股动脉穿刺插管行全脑血管造影显示有血管狭窄,行颈动脉支架置入术。结果成功置入支架后临床症状改善,术中、术后均出现并发症,经过积极有效的处理,患者康复出院。结论加强手术前后的护理,严密观察病情,积极治疗和处理并发症,是手术成功的关键。     

颈动脉内膜剥脱术的手术配合

目的：探讨颈动脉内膜剥脱术的术中护理配合。方法：对12例动脉硬化粥样硬化引起颈动脉狭窄的患者行颈动脉内膜剥脱术的术前准备、术中配合情况进行总结。结果：在充分的术前准备、良好的术中配合下以及准确了解手术者的手术习惯,颈动脉内膜剥脱术取得了较好的临床效果,无严重并发症发生。结论：良好的手术配合是提高手术疗效,保证患者安全不可或缺的重要组成部分。     

外翻式颈动脉内膜切除术治疗症状性颈动脉狭窄32例临床分析

目的 探讨应用外翻式颈动脉内膜切除术治疗症状性颈动脉狭窄对缺血性脑卒中的预防.方法 静吸复合麻醉下对32例症状性颈动脉狭窄患者行外翻式颈动脉内膜切除术.术中行全程经颅超声多普勒监测.结果 本组32例患者均成功完成外翻式颈动脉内膜切除术.17例因短暂性脑缺血发作(TIA)入院患者未再出现TIA发作,其他患者原有症状有不同程度好转或消失.患者术后72 h内发生TIA,24 h多次CT血管造影(CTA)检查无梗死灶出现,经小剂量尿激酶治疗后恢复.2例因切口肿胀出现严重气管移位,经鼻气管插管后,患者顺利渡过水肿期.4例患者出现头痛,经脱水药物治疗后均在术后2～3 d缓解.7例患者术后出现不同程度声音嘶哑,神经营养药物治疗1个月后恢复.无其他严重并发症发生.术后随访6个月,CTA复查无一例颈动脉再狭窄出现.结论 外翻式颈动脉内膜切除术是颈动脉狭窄的有效治疗方法,可有效预防缺血性脑卒中的发生.     

CEA在颈动脉重度狭窄患者中的应用研究

目的探讨颈动脉内膜剥脱术(CEA)在颈动脉重度狭窄患者中的应用价值。方法选取2014年1月-2015年12月惠州市第一人民医院联合龙门县人民医院收治的60例重度颈动脉狭窄患者为研究对象,随机分为CEA组与颈动脉支架成形术(CAS)组各30例。对比两组患者围手术期并发症发生率、术后3个月内心血管事件发生率,术后随访12个月,观察两组术侧颈动脉再狭窄的发生情况。结果 CEA组围术期并发症发生率为16.7%低于CAS组的20.0%,组间比较差异无统计学意义(P0.05)。术后3个月CEA组共发生4例心血管事件发生低于CAS组的6例,组间比较差异无统计学意义(P0.05)。随访期间CAS组出现颈动脉再狭窄4例,CEA组未见颈动脉再狭窄发生,组间比较差异有统计学意义(P0.05)。结论 CAS和CEA均可视为治疗重度颈动脉狭窄的有效方式,但后者操作简便,术中无严重并发症,且术后再狭窄发生率较低,因此在患者条件允许的情况下,可优先采用此术式。     

颈动脉内膜切除术适应证及疗效评价

目的　讨论颈动脉内膜切除术的适应证及效果。方法　对 8例颈动脉狭窄患者进行超声多普勒及DSA检查后施行了颈动脉内膜切除术 ,对术后患者用超声及DSA进行随访观察。结果　 8例手术患者无脑卒中发生 ,并且无手术后再狭窄。结论　颈动脉内膜切除术是治疗颈动脉狭窄的有效方法 ,适用于有症状、狭窄程度 >5 0 %的患者。但因其为预防性手术 ,对无明确颈动脉狭窄患者不宜过于积极行手术治疗。     

两种颈动脉内膜剥脱术式治疗颈动脉狭窄的临床对照研究

目的研究在翻转式颈动脉内膜剥脱术和颈动脉内膜剥脱并人工血管补片成形术两种治疗方法下颈动脉狭窄患者的不同临床效果,并分析其应用价值。方法选取我院收治的自2012年2月至2015年3月106例颈动脉狭窄患者作为研究对象,随机分为对照组和实验组,每组患者各53例,对照组患者使用翻转式颈动脉内膜剥脱术进行治疗,实验组患者使用颈动脉内膜剥脱并人工血管补片成形术进行治疗,比较两种方法治疗后患者的临床疗效。结果两组患者的手术均很成功,但实验组患者的手术时间、住院天数、抗生素的使用量、术中出血量均显著少于对照组,组间差异明显,具有统计学意义(P﹤0.05)。结论两种手术方法对于治疗颈动脉狭窄患者均有显著疗效,但颈动脉内膜剥脱并人工血管补片成形术具有手术时间短、住院天数少、抗生素使用率低、术中出血量少等优点,值得在临床上广泛推广。     

颈动脉内膜剥脱术的围术期护理

目的:探讨颈动脉内膜剥脱术围术期护理措施及要点。方法:选取住院病人17例,其中男性11例,女性6例,年龄在36~68岁之间,进行颈动脉剥脱术后护理及治疗。结果:患者术后均未出现并发症,13例病人术前临床症状完全消失,3例明显好转,1例出现偶有头晕,嘴角歪斜不明显症状。结论:针对颈动脉狭窄实施颈动脉内膜剥脱术患者,及早发现并治疗,术前及术后护理以及出院康复指导可帮助患者提升生活品质。     

颈动脉超声筛查在颈动脉狭窄与脑卒中高危人群中的应用价值评价

目的：讨论颈动脉超声筛查在颈动脉狭窄与脑卒中高危人群中的应用价值。方法：选取2019年6月～2020年12月150例脑卒中高危人群患者作为实验组,同期健康体检者150例作为对照组,对两组患者行颈动脉超声检查,采用Logistic回归分析脑卒中形成危险因素。结果：实验组吸烟史、高血压、冠心病、糖尿病、下肢动脉疾病的比例明显高于对照组（P<0.05）;独立危险因素为：下肢动脉疾病、吸烟史、高血压、糖尿病、冠心病。实验组的颈总动脉左侧内径（t=373.78,P=0.00）、右侧内径（t=23.76,P=0.00）、颈内动脉颅外段左侧内径（t=11.51,P=0.00）、右侧内径（t=72.39,P=0.00）均窄于对照组（P<0.05）。结论：下肢动脉疾病、吸烟史、高血压、糖尿病、冠心病均是脑卒中的独立危险因素,采用颈动脉超声诊断不仅能够帮助临床医生了解患者血管的狭窄程度,还可显示患者动脉粥样硬化斑块的性质,为临床诊断与治疗提供有利的参考依据。     

Carotid angioplasty and stenting: evolution and current status

The management of carotid stenosis is in evolution. Carotid endarterectomy has been the gold standard for the treatment of carotid stenosis for many years. However, recently, carotid angioplasty and stenting has emerged as a feasible and relatively safe management alternative. The appropriate clinical setting for its preferential use over carotid endarterectomy continues to be the subject of ongoing clinical trials. In this article, we review the evolution of carotid angioplasty and stenting, the evidence behind the current indications, and limitations of this procedure, as well as provide an overview of preprocedural evaluations and periprocedural management.     

颈动脉内膜剥脱术治疗症状性颈内动脉狭窄的疗效分析

目的 探讨颈动脉内膜剥脱术治疗症状性颈内动脉狭窄的效果.方法 回顾性分析2016年1月-2018年12月在朝阳市中心医院神经外科,行颈动脉内膜剥脱术治疗的46例症状性颈内动脉狭窄患者的临床资料,从神经功能、脑血流动力学及围手术期和远期不良事件等方面评价其治疗效果及安全性.结果 与术前相比,术后3个月患者狭窄段血管内径增大、狭窄段收缩期峰值血流速度降低,差异均有统计学意义(P<0.05).患者术后3个月改良Rankin量表评分较术前降低、蒙特利尔认知评估量表评分较术前提高,差异均有统计学意义(P<0.05).围手术期不良事件:术后出现脑过度灌注综合征、颈部切口积脓、心律失常、突发脑干出血死亡各1例.远期不良事件:术后4个月和8个月出现脑梗死各1例;术后5个月出现动脉内夹层1例.结论 颈动脉内膜剥脱术可有效改善症状性颈内动脉狭窄患者的神经功能和脑供血情况,疗效确切,安全性高.     

Carotid endarterectomy for women and men

Carotid endarterectomy is the standard of care for people with severe symptomatic carotid stenosis. We analyzed population administrative data and clinical trial data to determine whether sex differences exist in the use and outcomes of this surgical procedure. We studied patients in Ontario who underwent carotid endarterectomy between 1982 and 1994 (n = 12,949) and patients with severe carotid stenosis who were enrolled in two randomized trials of endarterectomy (n = 1646). We compared the proportion of men and women who underwent carotid endarterectomy in each group, over time, and after adjustment for demographic factors. Men were twice as likely as women to receive carotid endarterectomy in the administrative analysis (65% versus 35%, p < 0.001) and in the clinical trial analysis (70% versus 30%, p < 0.001). The relatively lower use in women was consistent in every age group and in every year studied. Men in the administrative database were somewhat less likely than women to die or be institutionalized after surgery (5% versus 6%, p = 0.007). Men in the clinical trial database were also less likely than women to experience perioperative stroke or death, although the results were not statistically significant (6% versus 7%, p = 0.32). Patients who were assigned to surgical therapy, compared with those assigned to medical therapy, had a significant decrease in the risk of adverse events at 1 year, and the net benefit appeared similar in women and men. Carotid endarterectomy is performed relatively infrequently on women despite their similar lifetime burden of disease and similar short-term perioperative risks compared with men.     

Stenting of symptomatic stenosis of the internal carotid artery is not preferred over endarterectomy at this time

Carotid endarterectomy reduces the risk of stroke in patients with symptomatic internal carotid-artery stenosis of 50% or greater. Carotid-artery stenting may be an attractive alternative. Two randomised trials comparing carotid endarterectomy with stenting have recently been terminated prematurely. Reasons for termination included an excess in stroke and death after stenting, compared with carotid endarterectomy (the EVA-3S trial) and futility reasons and the absence of funding (the SPACE trial). Given that both trials failed to prove the non-inferiority of stenting compared with carotid endarterectomy in the first 30 days, the use of stenting should be restricted to patients with contraindications to surgery and those participating in randomised clinical trials.     

Carotid artery stenting 2008

In an effort to minimize interventions, in the last decade carotid artery stenting (CAS) has been suggested as an alternative to surgical carotid endarterectomy (CEA) for patients with symptomatic and asymptomatic extra cranial obstructive disease. CAS is relatively new compared to CEA and it should be acknowledged that CAS is an evolving technique. As technology has improved, procedural risks have declined and are approaching those reported for CEA. From the individual randomised clinical trial it can be concluded that in patients at high risk for CEA, CAS is an equivalent, maybe better alternative. In symptomatic patients at standard risk for CEA, CAS has not proven non-inferior, and is worse when performed by relatively inexperienced operators without embolic protection device compared to highly experienced CEA surgeons.     

Endarterectomy should not be offered routinely to patients with asymptomatic carotid stenosis

A recent trial revealed a reduction in ischaemic infarcts after carotid endarterectomy in patients with asymptomatic carotid stenosis. However, the number needed to treat (NNT) was 19 to prevent one stroke in 5 years, a modest effect in comparison to the trials with symptomatic patients (a NNT of only 6 in patients with a symptomatic stenosis of 70-99%). Furthermore, the number of surgical complications outweighs the benefits of surgery during the first two years after treatment. Finally, the benefits also included the prevention of contralateral strokes, whereas it is unlikely that these are prevented by endarterectomy. Therefore, endarterectomy should not be performed routinely in asymptomatic persons.     

外翻式颈动脉内膜切除术治疗颈动脉粥样硬化性狭窄

目的 探讨外翻式颈动脉内膜切除术在治疗颈动脉粥样硬化性狭窄中的疗效.方法 总结2009年3-8月20例接受外翻式颈动脉内膜切除术的颈动脉粥样硬化性狭窄患者的临床资料,比较术前、术后的影像学资料和临床症状.结果 20例手术均获成功,患者术后临床症状均得到不同程度改善.患者在出院前均行颈动脉CT血管成像,显示狭窄处完全解除,吻合口扩张.结论 外翻式颈动脉内膜切除术治疗颈动脉粥样硬化性狭窄,具有手术时间短、术后再狭窄率低、增厚内膜及斑块剥离彻底等优点.