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[糖尿病患者颈动脉内膜切除术的围手术期安全性分析]

[Perioperative safety analysis of carotid endarterectomy in diabetic patients].

作者信息

Liu X N, Ni L, Wang W D, Zeng R, Liu C W

机构信息

Department of Vascular Surgery, Peking Union Medical Colloge Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2016 Nov 29;96(44):3549-3553. doi: 10.3760/cma.j.issn.0376-2491.2016.44.003.

Abstract

To compare perioperative outcome of carotid endarterectomy (CEA) between diabetic and non-diabetic patients and discuss the safety of CEA in diabetic patients. A total of 572 patients with carotid stenosis who underwent CEA from Juanuary 2006 to September 2014 in Peking Union Medical Colloge Hospital were collected and analyzed retrospectively. The patients were distributed into diabetes mellitus (DM) group and non-DM group according to the comorbidities. Their baseline characteristics, intraoperative index and major complications in perioperative period were analyzed and compared. Of 572 cases, 184 had DM (32.2%). Diabetic patients more frequently had a history of coronary artery disease (30.4% vs 18.6%), peripheral artery disease (39.7% vs 27.3%), and hyperlipemia (50.5% vs 36.6%) than non-diabetic patients (all <0.05). The incidence of perioperative myocardial infarction (0.5% vs 0.8%), stroke (1.6% vs 1.8%) and death (0.5% vs 0.3%) did not differ between two groups (all >0.05). Data of follow-up was available in 89.6% of patients, with a median duration of 42 months. The incidence of myocardial infarction (4.3% vs 3.4%), stroke (1.8% vs 1.7%), death (1.1% vs 0.9%), and restenosis (2.9% vs 3.1%) did not differ between two groups (all >0.05). DM does not increase the risk of perioperative complications and impair the long-term outcomes after CEA if the patients are appropriately evaluated and treated in perioperative period.

摘要

比较糖尿病患者和非糖尿病患者行颈动脉内膜切除术(CEA)的围手术期结局,并探讨CEA在糖尿病患者中的安全性。回顾性收集并分析了2006年1月至2014年9月在北京协和医院行CEA的572例颈动脉狭窄患者。根据合并症将患者分为糖尿病(DM)组和非DM组。分析并比较两组患者的基线特征、术中指标及围手术期主要并发症。572例患者中,184例患有DM(32.2%)。糖尿病患者较非糖尿病患者更常患有冠状动脉疾病(30.4%对18.6%)、外周动脉疾病(39.7%对27.3%)和高脂血症(50.5%对36.6%)(均P<0.05)。两组围手术期心肌梗死发生率(0.5%对0.8%)、卒中发生率(1.6%对1.8%)及死亡率(0.5%对0.3%)差异均无统计学意义(均P>0.05)。89.6%的患者有随访数据,中位随访时间为42个月。两组心肌梗死发生率(4.3%对3.4%)、卒中发生率(1.8%对1.7%)、死亡率(1.1%对0.9%)及再狭窄发生率(2.9%对3.1%)差异均无统计学意义(均P>0.05)。如果在围手术期对患者进行适当评估和治疗,DM不会增加CEA围手术期并发症的风险,也不会影响其长期预后。

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