颈动脉内膜切除术后早期并发症及影响因素VIP免费

空垡处型苤查!Q!i生!旦筮!!鲞笠!塑g丛!』!!垡：』!!Y!!!i：!!!：!!：盟!：!颈动脉内膜切除术后早期并发症及影响因素张利勇尹国阳王继跃焦力群陈东万晓楠石军伟凌锋【摘要】目的分析颈动脉内膜切除术后早期并发症的原因及其影响因素。方法回顾性分析2001年1月至2011年12月首都医科大学宣武医院、聊城市人民医院、大连市中心医院三家医院共494例连续颈动脉内膜切除术的患者资料，其中15例患者分期行双侧手术，共509例次。男性422例，女性72例，年龄35～84岁，平均(64±9)岁。分析颈动脉内膜切除术后30d内的各种并发症及原因，着重分析30d主要并发症的危险因素。使用卡方单因素分析，对患者人群的基本特征、临床特点及术中细节等每一个变量和术后早期不良事件之间的关系进行分析，使用Logistic回归分析评估患者各个因素之间的相关影响与术后30d内并发症的相关性。结果本组病例手术完成率为98．6％，7例完全闭塞的患者没有再通。术后30d内，发生主要并发症有20例(3．9％)，死亡6例(1．2％)，脑梗死9例(1．8％)，脑出血5例(1．O％)；次要并发症120例(23．6％)。单因素分析结果显示，患者改良Rankin量表(mRS)评分≥3分者术后早期并发症率发生率明显增高(x2=20．517，P<0．01)。多因素Logistic回归分析显示，吸烟(OR=2．667，95％CI：1．048—6．791，P=0．040)及mRS评分I>3分者(OR=8．690，95％CI：3．279—23．031，P=0．000)术后30d内主要并发症发生率显著增高。结论颈动脉内膜切除术的安全性较高，术后发生并发症的概率较低。吸烟和mRS评分≥3分的患者接受颈动脉内膜切除术治疗，围手术期并发症发生率显著增高。【关键词】颈动脉内膜切除术；手术后并发症；颈动脉狭窄；危险因素RetrospectivestudyfortheriskfactorsoftheearlycomplicationaftercarotidendarterectomyZhangLiyong+，YinGuoyang，WangJiyue，JiaoLiqun，ChenDong，耽几Xiaonan，鼬iJunwei，LingFeng．+DepartmentofNeurology，LiaochengPeople’SHospital，Liaocheng252000，ShandongProvince，ChinaCorrespondingauthortLingFmg．Email：lingfeng_vip@163．com【Abstract】0bjectiveToreviewtheinfluencingfactorsoftheearlycomplicationaftercarotidendarterectomy(CEA)．MethotisRetrospectiveanalysisofclinicaldataof509casesreceivedCEAinXuanWuHospitalofCapitalMedicalUniversity．LiaochengPeople’SHospitalandDalianCentralHospitalfromJanuary200ltoDecember2011．Thereare422malepatientsand72femalepatientsamongthe494patients，15patientsunderwentCEAbystages．Thepatientswerebetween35—84yearsold，andthemeanagewas(64±9)years．Thecomplicationswithin30daysafterCEAwereanalyzed，andfindtheriskfactorsforthemajoradverseevents．Chi—squareanalysiswasperformedtoanalyzethecorrelationbetweentheeachvariableofthebasiccharacteristicsofpopulation．clinicalfeaturesandintraoperativedataandearlyadverseeventsafterCEA．Logisticregressionanalysiswasusedtoassesstherelationshipbetweenavarietyoffactorsandthepostoperativecomplicationswithin30days．ResultsTechnicalcompleterateof98．6％．7casesofnear—totalocclusionpatientscouldnotbeenrecanalized．Majarcomplicationsin30daysafterCEAoccurredin20cases(3．9％)，including6casesofdeaths(1．2％)，9casesofcerebralinfarction(1．8％)and5casesofcerebralhemorrhage(1．0％)．Secondarycomplicationsoccunedin120cases(23．6％)．UnivariateanalysisshowedmodifiedRankinscale(mRS)≥3oatheincidenceofearlypostoperativecomplicationhadsignificantlydifference(x2=20．517，P<0．01)，multivariatelogisticregressionanalysisrevealedthatsmoking(OR=2．667，95％CI：1．048—6．79l，P=0．040)andmRS≥3(OR=8．690，95％c，：3．279—23．031，P=0．000)werethesignificantpredictorsof30daysoftheendevent．Conclusion7rhecomplicationsafterCEAareuncommon．thesecurityisproved．SmokingandmRSI>3canincreasether...