CAJ | 학술논문

目的探讨颈动脉内膜切除术(CEA)的围手术期并发症及其危险因素和防治策略.方法分析1987-2009年405例CEA术后发生的各类并发症37例的临床资料.结果 37例围手术期并发症包括:15例血流动力学不稳定、2例心肌缺血或梗死、2例暂时性脑缺血、4例脑梗死、2例脑出血、7例脑神经损害、2例喉头痉挛及其他3例.其中3例分别死于脑出血、心肌梗死和术区血肿.全组卒中/死亡率为1.98%.结论 CEA围手术期最常见的并发症是血流动力学不稳定,但不严重,经相应处理,多可在1-2 d内恢复正常.较常见的并发症是脑缺血,加强术中监测,选择性应用术中转流可降低该并发症.脑出血少见但可能致命,对颈动脉极度狭窄,且侧枝循环差者,应重视术后血压监控,慎用抗凝治疗.心肌梗死是CEA术后死亡的主要原因之一,全面的心血管系统评估和围手术期监测不可或缺.脑神经损伤不少见,多数症状较轻,可自行恢复,采用显微外科技术可有效降低其发生率.
목적 탐토경동맥내막절제술(CEA)적위수술기병발증급기위험인소화방치책략.방법 분석1987-2009년405례CEA술후발생적각류병발증37례적림상자료.결과 37례위수술기병발증포괄:15례혈류동역학불은정、2례심기결혈혹경사、2례잠시성뇌결혈、4례뇌경사、2례뇌출혈、7례뇌신경손해、2례후두경련급기타3례.기중3례분별사우뇌출혈、심기경사화술구혈종.전조졸중/사망솔위1.98%.결론 CEA위수술기최상견적병발증시혈류동역학불은정,단불엄중,경상응처리,다가재1-2 d내회복정상.교상견적병발증시뇌결혈,가강술중감측,선택성응용술중전류가강저해병발증.뇌출혈소견단가능치명,대경동맥겁도협착,차측지순배차자,응중시술후혈압감공,신용항응치료.심기경사시CEA술후사망적주요원인지일,전면적심혈관계통평고화위수술기감측불가혹결.뇌신경손상불소견,다수증상교경,가자행회복,채용현미외과기술가유효강저기발생솔.
Objective To study the risk fctors of perioperative complications of carotid endarterectomy(CEA) and their prevention and management. Method From 1987 to 2009 four hundred and five patients were performed carotid endarterectomy. The clinical data of thirty-seven patients who developed perioperative complications were analyzed. Rusults The complications included 15 cases of hemodynamic instability, 2 cardiac ischemia or infarction, 2 transient ischemic attack (TIA), 4 cerebral infarction, 2 cerebral hemorrhage, 7 cranial nerve injury, 2 laryngismus and 3 others. Three patients died from cerebral hemorrhage, myocardial infarction and wound hematoma respectively. The stroke/mortality rate in this series was 1.98%. Conclusion The hemodynamic instability which is the most common perioperative complication usually is mild and resolved in one to two days. Cerebral ischemia is a common complication after CEA, and can be reduced by intraoperative monitoring and selective shunting. Cerebral hemorrhage is rare but may be fatal and usually occur in those patients with tight carotid stenosis and lack of callateral circuration. Perioperative control of blood pressure is very important The anticoagulants should be used with caution. Myocardial infarction is a main cause of perioperative death, so the clinical evaluation and perioperative monitoring of cardiac function are mandatory. Cranial nerve injuries are among the most common complications. The majority of these injuries are subclinical or mild and recovered spontaneously.They can be effectively decreased by use of microendarterectomy.