糖尿病與頸動脈內膜剝脫術后并發癥發生率的相關性分析

【中圖分類號】R651；R743 【文獻標志碼】B 【文章編號】 1672-7770（2025）02-0210-05

Abstract：Objective To explore the correlation between diabetes and the incidence of complications after carotid endarterectomy（CEA）.MethodsA total of37O patientswhoreceived CEAat HandanFirst Hospital and Xingtai People's Hospital from January 2012 to December 2022 were colected.According to whether diabetes mellitus is complicatedor not，the subjects were divided into diabetic groupand non-diabetic group. Diabetic group had 139 patients （37.6% ），while 5O patientswith diabetes mainly treated with insulin （36.0% ），89 patients with diabetes treated only with oral hypoglycemic drugs（64.0%） . Non-diabetic group had 231 patients （62.4% ）.ResultsExcept for the high prevalence of dyslipidemia，coronary heart disease and peripheral vascular disease in patients with diabetes，the preoperative characteristics of other patients were similar. The incidence of postoperative cerebrovascular disease in diabetic patients （3.6% ）was higher than that in non-diabetic patients（ 0.4% ）（ P=0.03 ）.The incidence of postoperative heart failure in diabetic patients （5.8% ）was higher than that in non-diabetic patients （ P=0. 023 ）． The incidence of postoperative wound infection was 3，6% in diabetic patients and 0% in non-diabetic patients（ P=0. 007 ）.There was no significant diference infatal cardiac events，neurological eventsand mortality between thetwo groups（ Pgt; 0.05）．The proportion of total post-operativecomplications in the diabetic group was morethan twice as high as that in the non-diabetic group（ 20.1% Us 7.4% ， Plt;0.001 ）.ConclusionsDiabetes increases the surgical risk of CEA，but there isnosignificant increase intherisk offatality.Itisobserved that patientsonly treated with oral hypoglycemic drugs have a higher incidence of post-operative complications than patients treated with insulin.

Keywords：carotid endarterectomy；diabetes mellitus；post-operative complication

頸動脈狹窄是最常見的神經外科血管性疾病之一，且發病率呈上升趨勢。頸動脈內膜剝脫術（carotidendarterectomy，CEA）是當前臨床治療頸動脈狹窄的重要術式，其主要處理是將頸動脈病變處附著斑塊的內膜予以剝離，以此改善腦部血供，降低腦卒中發生風險[1]。CEA是治療分叉部頸動脈狹窄的首選方法，術后再狹窄率較低[2]。據文獻報道，在接受CEA的患者中，糖尿病患者的比例呈現遞增趨勢，從 10% 升至 25% 。糖尿病是普通人群中發生心肌梗死（myocardialinfarct，MI）和卒中的重要危險因素，也會影響CEA術后患者的預后[3]。有研究者認為，與非糖尿病患者相比，患有糖尿病的患者發生術后相關并發癥的風險高達兩倍[4]。另一些研究認為，糖尿病患者與非糖尿病患者在CEA術后在心臟病發病率、死亡率和卒中的風險上無明顯差異[5]。由于這些研究大多沒有納入糖尿病治療類型的差異進行分析，這可能是糖尿病對于患者CEA術后結局的影響的研究之間相互矛盾的原因。本研究納入2012年1月—2022年12月在邯鄲市第一醫院及邢臺市人民醫院接受CEA治療的370例患者，旨在探討合并及不合并糖尿病的患者CEA術后并發癥的發生率、糖尿病治療類型的不同影響，以及為手術安全性提供一些建議。

1資料與方法

1.1一般資料共納入370例患者，依據既往糖尿病病史及入院后監測血糖符合《中國2型糖尿病防治指南（2020版）》糖尿病診斷標準將患者分為兩組。糖尿病組139例，其中主要應用胰島素治療糖尿病（常短效胰島素結合應用，口服降糖藥物1 種）的患者50例，僅應用口服降糖藥物的患者89例，男82例，女57例；……