颈动脉内膜切除术围手术期并发症分析及管理策略  

Analysis of perioperative complications of carotid endarterectomy and management strategies

作　　者：化召辉[1] 张林枫[1] 徐鹏[1] 焦周阳[1] 曹辉[1] 刘仕睿 张麒[1] 张帅[1] 李震[1] 张玮[1] Hua Zhaohui;Zhang Linfeng;Xu Peng;Jiao Zhouyang;Cao Hui;Liu Shirui;Zhang Qi;Zhang Shuai;Li Zhen;Zhang Wei(Department of Endovascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,He'nan,China)

机构地区：[1]郑州大学第一附属医院腔内血管外科,河南郑州450052

出　　处：《血管与腔内血管外科杂志》2021年第1期14-18,共5页Journal of Vascular and Endovascular Surgery

基　　金：国家自然科学基金(81570458)。

摘　　要：目的分析颈动脉内膜切除术(CEA)术后30 d内并发症数据并探讨其管理策略。方法选取郑州大学第一附属医院2013年1月至2019年11月632例行CEA术治疗颈动脉狭窄患者的临床资料,根据围手术期并发症发生情况进行分组,分为发生组(n=62)和未发生组(n=570)。统计并比较围手术期并发生症(主要和次要)发生情况。结果632例CEA患者,围手术期主要并发症发生率为17.7%(11/62);次要并发症发生率为82.3%(51/62)。主要并发症中脑梗死5例、脑出血2例、急性血栓形成1例、急性喉头水肿1例,死亡2例,1例为颈部血肿窒息死亡、1例为术后心肌梗死死亡。次要并发症高灌注反应33例、颈部血肿11例、神经损伤7例。选择不同CEA术式患者围手术期并发症发生率比较,差异有统计学意义(P<0.05)。结论颈动脉内膜切除术的有效性在一定程度上取决于其并发症发生率,术前严格的适应证选择,规范的围术期评估与管理,可有效减少CEA并发症的发生。Objective To analyze the complications within 30 days after carotid endarterectomy(CEA)and explore its coping strategy.Method A total of 632 patients with carotid artery stenosis treated with CEA methods in the First Affiliated Hospital of Zhengzhou University from January 2013 to November 2019 were selected,and their clinical data were collected.The subjects were divided into groups according to perioperative complications occurrence(n=62)and non-occurrence(n=570).The incidence of complications(primary and secondary)during the perioperative period was calculated and compared.Result In 632 patients with CEA,the incidence of primary complications during the perioperative period was 17.7%(11/62);secondary complications were 82.3%(51/62).Among the primary complications,there were 5 cases of cerebral infarction,2 cases of cerebral hemorrhage,1 case of acute thrombosis,1 case of acute laryngeal edema,2 cases of death,1 case of neck hematoma asphyxia,and 1 case of postoperative myocardial infarction death.Secondary complications were 33 cases of hyperperfusion reaction,11 cases of neck hematoma,and 7 cases of nerve injury.The perioperative complication rate of patients with different CEA procedures was compared,and the difference was statistically significant(P<0.05).Conclusion The effectiveness of CEA depends on the incidence of complications to a certain extent.Strict preoperative selection of indications and standardized perioperative evaluation and management could effectively reduce CEA complications.

关 键 词：颈动脉内膜切除术 并发症 围手术期 手术方式 

分 类 号：R543[医药卫生—心血管疾病]