颈动脉内膜切除术后监护治疗的临床分析  

Clinical analysis on monitoring and comprehensive treatment after carotid endarterectomy

作　　者：王秀英[1] 孙正辉[1] 刘磊[1] 武琛[1] 冀蓁[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华医学杂志》2017年第20期1572-1575,共4页National Medical Journal of China

摘　　要：目的探讨颈动脉内膜切除术（CEA）后在监护室治疗期间综合治疗的临床经验。方法收集解放军总医院2007年7月至2017年1月共315例颈动脉粥样硬化性狭窄患者的临床资料，所有患者均接受了气管插管全身麻醉、颈动脉内膜切除术，术后带气管插管麻醉状态下转入监护室，继续心电监护、给予呼吸机辅助呼吸、短期镇静，严密监测血流动力学及瞳孔变化，严格控制心率、血压、雾化化痰，给予适当的抗凝、抗血小板、防治并发症等治疗。结果315例患者均恢复良好，无死亡病例；心率、血压均控制在要求范围内，其中2例患者出现颅神经损伤，6例患者出现切121渗血，4例患者术后因气道梗阻明显再次开放气道，2例患者出现肺炎，1例患者出现失语及同侧偏瘫，1例患者因不稳定性斑块脱落致术后短期意识障碍、偏瘫，8例患者出现精神症状，1例患者出现急性心肌梗死。结论CEA术后继续短期镇静、严密控制血压和心率、气道的分级管理、低分子肝素与阿司匹林联合应用抗凝抗血小板等综合措施，可利于麻醉苏醒平稳恢复、血压控制满意，可有效降低术后脑高灌注综合征的发生率，保证颈动脉切除术的治疗效果。Objective To discuss the therapeutic effect of management of carotid endarterectomy in care unit. Methods A total of 315 patients with carotid atherosclerotic stenosis were enrolled. All of the patients were taken into care unit under tracheal intubation anesthesia after carotid endarterectomy. Then the patients were managed with a breathing machine, continuous sedation, strict monitoring of hemodynamics and pupil change, strict control of heart rate and blood pressure, atomization inhalation therapy, treatment of anticoagulafion and antiplatelet therapy and classification management of airway. Results All patients were recovered well and no death was documented, among which cranial nerve injury occurred in 2 cases, incision bleeding was observed in 6 patients, endotracheal intubation were performed again in 4 cases due to postoperative airway obstruction, pneumonia was found in 2 cases, aphasia and hom01ateral hemiplegia were observed in one case, while disturbance of consciousness and contralateral hemiplegia occurred in 1 case, psychiatric symptoms occurred temporarily after operation in 8 cases, and one case suffered from acute myocardial infarction. Conclusion The present study suggests that the comprehensive measures, including continuous sedation, strict control of heart rate and blood pressure, classification management of airway and so on, can be beneficial to postoperative anesthesia recovery and ideal blood pressure, and prevent the occurrence of cerebral hyperperfusion syndrome effectively.

关 键 词：颈动脉狭窄 颈动脉内膜切除术 再灌注损伤 镇静 

分 类 号：R651.12[医药卫生—外科学]