同期冠状动脉旁路移植术加颈动脉内膜剥脱术治疗冠心病合并颈动脉狭窄的疗效

doi:10.6040/j.issn.1671-7554.0.2014.787

摘要/Abstract

摘要： 目的总结同期冠状动脉旁路移植术(CABG ) 加颈动脉内膜剥脱术( CEA )治疗冠心病合并颈动脉狭窄的临床经验, 探讨手术方法及近中期疗效。方法回顾性分析2008年7月至2013年11月22例冠状动脉狭窄合并严重颈动脉狭窄患者同期行CABG与CEA手术的临床资料,并且对患者进行术后随访。结果围术期无心肌梗死及脑部并发症发生,1例同时行主动脉瓣、二尖瓣置换术后并发肾功能衰竭死亡,21例痊愈出院。术后随访20例,1例失访,随访率95.2%(20/21),随访12至76个月,平均(44.3±20.2)个月。1例术后3年出现心绞痛,其余患者无心绞痛发作,心功能明显改善;所有患者均无新发脑梗死,16例术前严重头痛、头晕症状明显好转。全部患者术后均经颈动脉超声或颈部血管CTA检查显示,颈动脉内膜剥脱加宽部位血流通畅,术后颈动脉血管内径、血流速度、左室射血分数(LEVF)较术前差异有统计学意义(P<0.05)。结论同期冠状动脉旁路移植术加颈动脉内膜剥脱术是治疗冠心病合并颈动脉狭窄安全有效的方法。

关键词: 冠状动脉旁路移植术, 冠心病, 颈动脉狭窄, 颈动脉内膜剥脱术

Abstract: Objective To summarize the clinic experiences of coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) in the treatment of carotid arteriostenosis and coronary heart diseases, and investigate the operation approaches and curative effects. Methods Clinical data of 22 patients with carotid arteriostenosis complicated with coronary artery diseases who underwent CEA and CABG during July 2008 and Nov 2013 in Qilu Hospital of Shandong University were retrospectively reviewed. Results One patient who underwent double valve replacement due to renal failure died. No cerebral complications were found during the perioperative period. A total of 20 patients (95.2%, 20/21) were followed up for 12-76 months (mean 44.3±20.2 months). Angina occurred in 1 patient three years after operation, while other patients had no symptoms of angina, and their cardiac function were improved significantly. No stroke was found. Of the 16 patients who had severe brain ischemia, the symptoms were remarkably improved after the surgery. Carotid duplex ultrasound or carotid CTA results showed that carotid arteries were widened, and blood flow was smooth. There were statistical differences in blood flow velocity, diameter of vessels and left ventricular ejection fraction (LVEF) before and after operation (P<0.05). Conclusion Concomitant CABG and CEA is safe and effective for patients with carotid arteriostenosis and coronary artery diseases.

Key words: Coronary artery bypass grafting, Carotid endarterectomy, Carotid arteriostenosis, Coronary heart disease

中图分类号:

R654.2

屈庆喜, 赵鑫, 孙文宇, 宋光民, 孟祥斌, 毕研文. 同期冠状动脉旁路移植术加颈动脉内膜剥脱术治疗冠心病合并颈动脉狭窄的疗效[J]. 山东大学学报（医学版）, 2015, 53(5): 71-74.

QU Qingxi, ZHAO Xin, SUN Wenyu, SONG Guangmin, MENG Xiangbin, BI Yanwen. Treatment of coronary heart diseases complicated with carotid arteriostenosis with coronary artery bypass grafting plus carotid endarterectomy[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(5): 71-74.

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