参麦注射液联合右旋糖酐、阿司匹林在预防颈动脉内膜剥脱术后并发症中的应用价值

Value of Shenmai Injection combined with dextran and Aspirin in prevention of postoperative complications after carotid endarterectomy

目的探讨围手术期应用参麦注射液联合右旋糖酐、阿司匹林预防颈动脉内膜剥脱(CEA)术后并发症中的应用价值。方法回顾性分析齐齐哈尔医学院附属第三医院接受在CEA手术治疗的颈动脉狭窄患者122例作为观察对象,根据患者围手术期处理措施分为A、B、C 3组,A组39例仅施行建立临时转流的CEA手术,B组35例CEA术后早期应用右旋糖酐与阿司匹林抗凝抗栓治疗方案,C组48例CEA围手术期静滴参麦注射液,术后早期应用右旋糖酐与阿司匹林抗凝抗栓方案,比较3组治疗效果及并发症发生情况。结果 3组患者术后6个月头晕、视力模糊、面部针扎感、上肢沉重感、大脑中动脉收缩期峰值、颈动脉收缩期峰值比较差异无统计学意义(P>0.05)。3组患者围手术期在过度灌注、局部血肿、脑组织损伤和心率、血压降低各项比较差异无统计学意义(P>0.05),在主要并发症发生情况总体比较中差异有统计学意义(P <0.05),组间两两比较,A组与C组比较,B组与C组比较,差异均有统计学意义(P <0.0167)。术后脑卒中、心肌梗死、死亡的比较差异无统计学意义(P>0.05),总体发生情况的比较差异有统计学意义(P <0.05),组间两两比较,A组与C组比较,B组与C组比较,差异均有统计学意义(P <0.0167)。3组患者在1年后随访致残、致死性卒中,以及总体情况比较差异无统计学意义(P>0.05)。结论 CEA围手术期应用参麦注射液联合右旋糖酐、阿司匹林可有效降低CEA围手术期并发症及不良结局发生率,并且对手术治疗效果无影响,具有临床应用及推广价值。

Objective To discuss the value of Shenmai Injection combined with dextran and Aspirin in the prevention of postoperative complications after carotid endarterectomy(CEA).Methods A retrospective analysis of 122 patients with carotid artery stenosis treated by CEA in our hospital was conducted.According to the perioperative management,all the patients were divided into groups A,B and C.The 39 patients in the group A were only implemented temporary bypass CEA surgery,the 35 cases in the group B had early application of dextran and Aspirin anticoagulant antithrombotic therapy after CEA,and the 48 cases in the group C had perioperative intravenous injection of Shenmai Injection and early postoperative application of dextran and Aspirin anticoagulant antithrombotic regimen.The therapeutic effect and occurrence of complications were compared among the three groups.Results After surgery,there were no significant differences in dizziness,blurred vision,facial acupuncture sensation,upper limb heavy feeling,middle cerebral artery systolic peak or carotid systolic peak among the three groups(P>0.05).There were no statistically significant differences in perioperative hyperperfusion,local hematoma,brain injury,heart rate,or blood pressure reduction among the three groups of patients(P>0.05);there was a significant difference in the overall comparison of the occurrence of major complications among three groups(P<0.05),there were significant differences between the groups A and C,and also between the groups B and C(P<0.05).There were no statistical differences in postoperative stroke,myocardial infarction or death(P>0.05),but the overall occurrence was significantly different(P<0.05);in inter-group comparison,there were significant differences between the groups A and C and between the groups B and C(P<0.05).There were no statistical differences in disability,fatal stroke,or overall condition among the three groups during the follow-up 1 y after surgery(P>0.05).Conclusions Perioperative use of Shenmai Injection combined with dextran and Aspirin can reduce perioperative complications of CEA and adverse outcomes,but has no effect on the treatment effect,with clinical application and promotion value.