颈动脉内膜切除术后早期死亡原因分析

目的 探讨颈动脉内膜切除术（carotid endarterectomy，CEA）后患者的死亡原因。方法 回顾性分析自2001年1月～2011年9月宣武医院神经外科连续收治的302例行CEA治疗的颈动脉狭窄患者，其中6例患者分期行双侧手术，每例按2例单独病例进行统计，共计308例。统计术后死亡患者例数及其死亡原因，分为生存组及死亡组，比较两组性别、年龄、既往病史、有无卒中或短暂性脑缺血发作症状、术前改良Rankin评分（modified Rankin Scale，mRS），及术后并发症对死亡率的影响。结果 死亡组与生存组的吸烟患者所占百分数分别为32.9%、100%，差异具有显著性（P=0.013）。死亡组与生存组男性、70岁以上所占百分数分别为100%、89.8%，25.0%、25.7%；两组在性别、高龄构成比方面差异无显著性。而伴既往短暂性脑缺血发作（transient ischemic attack，TIA）、脑梗死病史、高血压病、糖尿病、高脂血症、冠状动脉粥样硬化性心脏病等危险因素的患者在生存组与死亡组构成比比较差异均无显著性。无症状患者在生存组与死亡组的百分数分别为3.0%、0%，差异无显著性。mRS评分＜3分的患者在生存组与死亡组所占百分数分别为91.4%、100%，差异无显著性。术后脑出血发生率生存组与死亡组分别为2.0%、50.0%，差异具有显著性（P=0.003）。术区血肿发生率生存组与死亡组分别为6.9%、50.0%，差异具有显著性（P=0.029）。而术中转流、经颅多普勒超声（transcranial Doppler，TCD）监测栓子的数量≥20、心脏并发症、术后脑梗死等患者在生存组与死亡组所占百分数比较差异无显著性。结论 既往有吸烟史、术后并发脑出血或术区血肿的患者CEA死亡率升高，术前详细评估，积极预防术后脑出血及术区血肿是降低死亡率的关键措施。

Causes of Death in Carotid Endarterectomy

Objective To investigate the causes of death after carotid endarterectomy(CEA).
Methods Three hundred and two patients who underwent CEA for carotid artery stenosis in Xuanwu Hospital from January 2001 to September 2011 were retrospectively analyzed(6 of them underwent bilateral operation at two different stages, each patient was calculated as 2; therefore there were a total of 308 patients). We statistically analyzed the number of those patients who died after CEA and their causes of death. Those patients were divided into two groups: survival group and death group. The following data, including gender, age, past history, previous stroke, transient ischemic attack(TIA), modified Rankin Scale(mRS), the influence of complications after surgery on death, were compared.
Results There was significant difference in smoking between death group and survival group(100% vs 32.9%, P=0.013). There were no significant differences in the constituent ratios of gender(male) and age more than 70 years old between both groups(100% vs 89.8%, 25.0% vs 25.7%). There were no significant differences between both groups in those risk factors, such as TIA, cerebral infarction, hypertension, diabetes mellitus, hyperlipemia and coronary heart diseases. There were no significant differences in patients without symptoms and in patients with mRS3 between both groups. There were significant differences in postoperative cerebral hemorrhage between both groups(50.0% vs 2.0%, P=0.003; 50.0% vs 6.9%, P=0.029). There were no significant differences in shunting, the number of embolus 20(monitored by transcranial Doppler[TCD]), cardiac complications, postoperative cerebral infarction between both groups.
Conclusions A higher mortality is found in those patients who underwent CEA with smoking history, postoperative cerebral hemorrhage and subcutaneous hematoma. The key measures to reduce the mortality are careful evaluation before the surgery, progressive prevention against postoperative cerebral hemorrhage and subcutaneous hematoma.