颈动脉内膜切除术中应用鱼精蛋白中和肝素的临床观察  

Clinical observation of neutralizing heparin with protamine in carotid endoarterecomy

作　　者：刘琦[1] 陈跃鑫[1] 倪冷[1] 陈宇[1] 刘昌伟[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院血管外科,100730

出　　处：《中华医学杂志》2013年第33期2650-2653,共4页National Medical Journal of China

摘　　要：目的评价颈动脉内膜切除术中应用鱼精蛋白中和肝素对术中止血时间、术后引流量及相关并发症的影响。方法收集2012年1至12月于北京协和医院行颈动脉内膜切除术治疗的125例次颈动脉狭窄患者的病例资料，进行回顾性队列研究。根据术中是否使用鱼精蛋白，将患者分为鱼精蛋白组和非鱼精蛋白组。分析和比较两组的病例资料、术中止血时间、术后伤口引流量及相关并发症。结果125例次颈动脉内膜切除术中鱼精蛋白组共75例次，非鱼精蛋白组共50例次。鱼精蛋白组术后第1天伤口引流量少于非鱼精蛋白组，分别为（14±13）ml和（19±12）ml，P：0．038；鱼精蛋白组术后总引流量平均值小于非鱼精蛋白组，分别为（20±17）ml和（26±15）ml，P=0．035；鱼精蛋白组术中止血时间较非鱼精蛋白组缩短，分别为（30±11）min和（36±11）min，P=0．030。125例次手术无一例因手术死亡，其中1例（0．8％）发生切口血肿，急诊行血肿清除后恢复良好，1例（0．8％）患者发生术后脑卒中加重，经内科保守治疗后好转。结论颈动脉内膜切除术中选择性使用鱼精蛋白，对缩短术中止血时间、减少术后伤口引流量有积极作用，且不增加缺血性脑卒中的风险。ObjectiveTo evaluate the effects of administrating protamine to reverse heparin on intraoperative hemostatic time, postoperative drainage and postoperative complications in carotid endoarterectomy. Methods A retrospective cohort study of 125 cases of carotid endoarterectomy was undertaken at Department of Vascular Surgery, Peking Union Medical Hospital in 2012. They were divided into 2 groups： heparin （ H group ） and heparin ＋ intra-operative administration of protamine （ H ＋ P group）. Their medical history, preoperative clinical findings, intraoperative hemostatic time, postoperative drainage volume and complications were compared between two groups and statistically analyzed. Results Fifty cases received heparin alone and 75 cases had heparin reversal with protamine. Drainage volumes at Day 1 postoperation were less in H ＋ P group than those in H group with statistically significant difference （（14 ± 13） vs （19 ± 12） ml, P =0. 038）. And total postoperative drainage volumes were less in H ＋ P group with statistical significant difference （ （ 20± 17 ） vs （ 26 ± 15 ） ml, P = 0. 035 ）. Intraoperative hemostatic time was less in H ＋ P group than that in H group with statistical significant difference （ （ 30 ± 11 ） vs （36 ± 11 ） min, P = 0. 030）. There was no mortality. Only one case was re-operated for cervical hematoma. Cerebral ischemic symptoms of one patient in the H ＋ P group became worse postoperatively and recovered after conservative medical treatment. Conclusions During carotid endoarterectomy, the application of protamine may significantly decrease intraoperative hemostatic time and postperative wound drainage. And protamine has no effect of increasing the risks of periperative stroke.

关 键 词：颈动脉狭窄 颈动脉内膜切除术 鱼精蛋白 肝素 

分 类 号：R651.1[医药卫生—外科学]