羟乙基淀粉对短暂性脑缺血发作手术患者的疗效及安全性分析

Analysis of the efficacy and safety of hydroxyethyl starch on patients with transient ischemic attack undergoing carotid artery surgery

目的对于短暂性脑缺血发作行颈动脉手术治疗的患者,围手术期应用羟乙基淀粉40氯化钠,评价其有效性及安全性。方法选取2020年1月至2022年1月住院治疗的因颈动脉狭窄致脑缺血发作患者70例为研究对象,随机分为治疗组和对照组,每组35例,2组患者的一般情况差异无统计学意义(P>0.05)。治疗组分别于术前3 d及术后7 d给予羟乙基淀粉氯化钠注射液(500 ml,1次/d)治疗,对照组只给予患者和治疗组一样的基础治疗(扩血管及抗血小板聚集、抗凝等),分别于7 d、14 d观察2组患者的治疗效果、不良事件发生、外周血炎性因子(IL-6、IL-10、TNF-α)及凝血功能指标变化。结果2组患者NIHSS/GCS量表评分较治疗前均改善,且治疗组NIHSS/GCS评分较同期对照组改善明显,差异均有统计学意义(P<0.05),治疗后患者的外周血IL-6、TNF-α均低于治疗前,IL-10水平则高于治疗前,治疗组的指标变化幅度高于对照组(P<0.05),术后随访2组患者凝血功能改变无统计学差异(P>0.05)。2组患这围手术期不良事件发生无统计学差异(P>0.05)。结论羟乙基淀粉40氯化钠可用于因颈动脉狭窄致短暂性脑缺血发作的围手术期治疗,可显著改善患者低灌注症状,降低炎症反应,同时凝血功能并无显著变化,具有一定的安全性。

Objective To evaluate the efficacy and safety of perioperative application of sodium chloride hydroxyethyl starch 40(HSH40)on patients with transient ischemic attack undergoing carotid artery surgery.Methods A total of 70 patients with ischemic attack due to carotid artery stenosis hospitalized in our department from January 2020 to January 2022 were recruited.They were randomly assigned into treatment group(n=35)and control group(n=35).There were no significant differences in baseline characteristics between the two groups(P>0.05).Basic treatment,like vasodilator,antiplatelet aggregation and anticoagulation therapy was given to all patients,and those in the treatment group were additionally given HSH40500ml,q.d.on 3 days preoperatively and 7 days postoperatively.The treatment effect,adverse events,peripheral blood inflammatory factors,including interleukin 6(IL-6),IL-10 and tumor necrosis factor alpha(TNF-α),and coagulation were observed on 7 days and 14 days respectively.Results The National Institutes of Health Stroke Scale(NIHSS)/Glasgow Coma Scale(GCS)scores of patients in both groups were significantly improved compared with those before treatment,which were more pronounced in the treatment group(P<0.05).After treatment,the peripheral IL-6 and TNF-αlevels were significantly lower,and IL-10 was significantly higher than those before treatment,which were more common in the treatment group than those of control group(P<0.05).There was no significant difference in the changes of blood coagulation function between the two groups after follow-up(P>0.05).There was no significant difference between the two groups in the incidence of adverse events during the perioperative period(P>0.05).Conclusion HSH40 can be used in the perioperative treatment of transient ischemic attacks caused by carotid stenosis,which can significantly improve the hypoperfusion symptoms.It can reduce the inflammatory reaction without causing significant changes in the coagulation function,indicating the high safety.