本文選題：頸動脈狹窄　切入點：頸動脈內(nèi)膜切除術(shù)　出處：《大連醫(yī)科大學》2017年碩士論文

【摘要】：研究背景:腦血管病是一種常見疾病,主要與顱內(nèi)血管或與顱內(nèi)血管相關(guān)的頸部血管發(fā)生病變有關(guān)。有關(guān)資料統(tǒng)計,因疾病造成人類死亡的原因中,腦血管病的排位非�？壳�,一直穩(wěn)定在前三位,嚴重影響著人類的正常生活和身體健康。因現(xiàn)代人飲食攝入,生活習慣發(fā)生改變,人口老齡化不斷加重,導(dǎo)致腦血管病的發(fā)生率在不停升高。腦血管病包括兩種,第一種稱為缺血性腦血管病,第二種稱為出血性腦血管病。其中以缺血性腦血管病在臨床較多見,約占全部患者的84%。缺血性腦血管病是因為腦組織血管粥樣硬化,造成顱內(nèi)血管管腔縮窄,相應(yīng)血管內(nèi)血流量下降或全部中斷,血供嚴重減少,大腦缺乏氧氣,腦組織受到損傷而出現(xiàn)的一系列癥狀�，F(xiàn)階段,我國醫(yī)治缺血性腦血管病主要分為內(nèi)科保守治療及外科手術(shù)治療。內(nèi)科主要以擴容、溶栓、抗凝、抗血小板聚集及促進腦功能恢復(fù)等措施為主。由于神經(jīng)細胞為不可再生細胞,且溶栓治療需要把握好時間窗,腦細胞耐受缺氧的時間非常有限。因此,對已經(jīng)發(fā)生缺血或梗死的腦組織行內(nèi)科治療,其療效往往不是非常理想。外科治療中的頸動脈內(nèi)膜剝脫術(shù)(CEA)是重要手段,該手術(shù)通過直接切開病變血管,取出堵塞血管管腔的增厚內(nèi)膜和斑塊,從而恢復(fù)血管管腔血流,改善腦部循環(huán)。頸動脈內(nèi)膜剝脫術(shù)(CEA)能夠去除引發(fā)腦中風的病因,因此能夠起到預(yù)防腦中風發(fā)作的重要作用。對已患有腦中風的病人,如若盡早地進行頸動脈內(nèi)膜剝脫術(shù),改善腦部血供,對因中風導(dǎo)致的腦損傷的恢復(fù)也是十分樂觀的。因此,目前為止在國內(nèi)外CEA仍被看作治療頸動脈狹窄的金標準方法。目的:對一側(cè)頸動脈狹窄患者行狹窄側(cè)頸動脈內(nèi)膜切除術(shù)后,對非手術(shù)的另一側(cè)頸動脈、椎動脈血流速度變化進行分析和比較。從而探索血液動力學改變對病情的評估及對疾病診治和預(yù)防的重要意義。方法:對2009年4月至2014年4月大連市中心醫(yī)院神經(jīng)外三科診治的一側(cè)頸動脈重度狹窄(70～99%),伴對側(cè)頸動脈無或僅有輕度狹窄的患者50例進行回顧性數(shù)據(jù)分析。所有患者均進行了狹窄側(cè)CEA手術(shù)。對全部病人均行隨訪,分別于CEA術(shù)后1周、1月、6月及12個月進行頸部血管超聲診查,并記錄手術(shù)側(cè)及對側(cè)頸總、頸內(nèi)、椎動脈的血流速度數(shù)據(jù),并對所有數(shù)據(jù)進行比較和統(tǒng)計學分析。結(jié)果:所有手術(shù)均獲得成功,術(shù)后狹窄側(cè)頸動脈血流通暢,血流動力學恢復(fù)正常,且所有患者癥狀得到明顯改善。對側(cè)頸總、頸內(nèi)、椎動脈血液流速與術(shù)前血液流速相比降低,差異顯著并具有統(tǒng)計學意義(P0.05)。結(jié)論:重度狹窄側(cè)頸動脈行CEA術(shù)后,狹窄對側(cè)頸動脈、椎動脈系統(tǒng)血流速度呈總體下降趨勢。且血流速度的改變多從CEA術(shù)后早期開始。但病變對側(cè)血管血流速度下降后,會引起相應(yīng)血管血流剪切力下降,增大斑塊形成的風險。因此,在對狹窄血管施行CEA手術(shù)后,應(yīng)繼續(xù)控制動脈硬化危險因素,并密切觀察對側(cè)血管內(nèi)膜變化情況。
[Abstract]:Background: cerebrovascular disease is a common disease, mainly with intracranial vessels or associated with intracranial vascular neck vascular lesions occur. The statistics, because of the disease cause of human death, cerebrovascular disease ranked very near the top, has been stable in the top three, seriously affected people's normal life intake and body health. Because of modern diet, lifestyle changes, increasing aging population, resulting in an increased incidence of cerebrovascular disease in time. Cerebrovascular disease includes two kinds, the first is called ischemic cerebrovascular disease, second for hemorrhagic cerebrovascular disease. The ischemic cerebral vascular disease in the clinic, accounting for all 84%. in patients with ischemic cerebrovascular disease is because brain tissue caused by atherosclerotic vascular sclerosis, intracranial vascular lumen narrowing, corresponding intravascular blood flow decreased or interrupted, the blood supply is severely reduced, The brain lack of oxygen, a series of symptoms of brain damage appear. At this stage, China's treatment of ischemic cerebrovascular disease is mainly divided into conservative treatment and surgical treatment. Surgical department mainly in the expansion, thrombolysis, anticoagulation, antiplatelet aggregation and the main measures to promote recovery of brain function. Because nerve cells as non renewable cells. And thrombolytic therapy requires a good grasp of the time window, brain cells, hypoxia tolerance time is very limited. Therefore, to have occurred ischemia or infarction of brain tissue for medical treatment, the curative effect is not very ideal. In the surgical treatment of carotid artery endarterectomy (CEA) is an important means of the surgical incision through direct vascular lesions remove the blockage of blood vessels, intimal thickening and plaque, lumen to restore blood flow, improve cerebral circulation. Carotid endarterectomy (CEA) to remove the cause of stroke, It can play an important role in the prevention of stroke attack. For patients suffering from stroke, if early carotid endarterectomy, improve the brain blood supply to the brain damage caused by stroke, the recovery is also very optimistic. Therefore, so far at home and abroad, CEA is still considered the gold standard for the treatment of cervical arterial stenosis. Objective: to patients with unilateral carotid stenosis carotid artery endarterectomy, carotid artery on the other side of non surgery, vertebral artery blood flow velocity were analyzed and compared. In order to explore the change of hemodynamics evaluation of the disease and the significance of the treatment and prevention of diseases. Methods: severe on April 2009 to April 2014 Dalian Central Hospital for diagnosis and treatment of neurological side of carotid artery stenosis (70 ~ 99%), with contralateral carotid artery with mild or no stenosis in 50 cases were retrospectively data Analysis. All patients underwent CEA surgery. On the narrow side of all the patients were followed up respectively in 1 weeks after CEA, January, and June were neck vascular ultrasound examination for 12 months, and recorded the operation side and the contralateral carotid, internal carotid and vertebral artery blood flow velocity data, and according to the number of all comparison and statistical analysis. Results: all the operations were successful, postoperative stenosis of carotid artery blood flow hemodynamics returned to normal, and all patients improved symptoms. The contralateral carotid, internal carotid and vertebral artery blood flow velocity and blood flow decreased compared with preoperative, and significant difference was statistically significant (P0.05) conclusion: severe stenosis of carotid artery stenosis after CEA, contralateral carotid artery, vertebral artery blood flow velocity showed an overall downward trend. And the blood flow velocity changes from the early stage after CEA. But the rate of decline of blood vascular lesions side flow, cause The corresponding blood flow and shear force will decrease and increase the risk of plaque formation. Therefore, after performing CEA operation on narrow vessels, we should continue to control the risk factors of atherosclerosis and observe intimal changes of contralateral vessels closely.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.12
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本文編號：1717022