颈动脉内膜剥脱术后颈部神经损伤的危险因素分析

目的 探讨颈动脉内膜剥脱术(CEA)后颈部神经损伤(CNI)的相关危险因素。方法 采用回顾性研究方法。纳入天坛医院2012年4月—2015年5月209例CEA患者的临床资料,其中男177(84.69%)例、女32(15.31%)例,年龄42~80(67.5±8.8)岁。(1)统计患者术后CNI的发生率及临床表现。(2)纳入性别、年龄、有无糖尿病等影响因素,做CNI的单因素和多因素logistic回归模型分析;采用比值比(OR)及95%可信区间(CI)进行风险评估。结果 (1)209例患者术后有16例发生CNI,发生率7.66%。其中迷走神经损伤的患者最多,为9例(4.3%),表现为术后声音嘶哑;其次为舌下神经损伤3例(1.44%),症状较轻。出院时CNI临床症状基本消失。(2)单因素分析显示,糖尿病OR(95% CI)为2.782(0.990～7.819),P＜0.05]、年龄70～80岁OR(95% CI)为3.58(1.268～10.111),P＜0.05]、女性OR(95% CI)为3.854(1.292～11.499),P＜0.05]是影响CNI发生的相关因素。多因素回归分析显示,糖尿病OR(95% CI)为3.594(1.188～10.878),P＜0.05]、年龄70～80岁OR(95% CI)为5.024(1.625～15.528),P＜0.01]、女性OR(95% CI)为5.353(1.615～17.737),P＜0.01]是CNI的独立危险因素。结论 糖尿病、年龄70～80岁、女性是 CEA术后CNI的独立危险因素。因此,对于高龄女性糖尿病CEA患者围术期需给予更多关注。

Analysis of the risk factors of cervical nerve injury after carotid endarterectomy

Objective To investigate the risk factors of cervical nerve injury (CNI) after carotid endarterectomy (CEA). Methods We retrospectively analyzed 209 cases of CEA in Tiantan Hospital from April 2012 to May 2015, including 177 males (84.69%) and 32 females (15.31%) aged 42-80(67.5±8.75) years old. (1) Postoperative CNI was statistically analyzed. (2) Univariate and multivariate logistic regression analyses were performed to determine the risk factors of CNI, including gender, age, and diabetes. Risk factors for CNI were assessed by odds ratios(OR) and 95% confidence intervals(CI). Results Sixteen cases developed CNI after surgery. The incidence was 7.66%. The main symptom was vagus nerve injury (9 cases, 4.3%), which was manifested as hoarseness after surgery, followed by hypoglossal nerve injury (3 cases, 1.44%), which was manifested by mild symptoms and disappeared upon discharge from the hospital. (2) Univariate analysis showed that diabetes mellitus (OR95% CI]: 2.782 0.990-7.819], P＜0.05), age 70-80 years (OR95% CI]: 3.58 1.268-10.111], P＜0.05), and female gender (OR95% CI]: 3.854 1.292-11.499], P＜0.05) were related factors affecting the occurrence of CNI. Multivariate regression analysis showed that diabetes mellitus (OR95% CI] 3.594 1.188-10.878], P＜0.01), age 70-80 years (OR95% CI]: 5.024 1.625-15.528], P＜0.01), and female gender (OR95% CI]: 5.353 1.615-17.737], P＜0.01) were independent risk factors for CNI. Conclusions Diabetes, age 70-80 years, and female gender are independent risk factors for CNI after CEA surgery. Therefore, more attention should be paid to elderly female diabetic patients with CEA.