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目的分析颈动脉内膜剥脱术后并发症的原因并探讨其防治措施。方法回顾性分析99例因严重颈动脉狭窄(狭窄率70%~99%)而行颈动脉内膜剥脱术104侧的临床资料。结果术后颈动脉血栓形成至缺血性卒中1例,颈内动脉夹层至缺血性卒中2例,死亡2例(1例为77岁老年患者,术后次日发生急性心肌梗死,术后1个月死亡;另1例缺血性卒中并发上消化道出血死亡),脑过度灌注综合征3例,术区血肿形成1例。结论术前评估、术中操作及判断不当、严重高血压是导致术后并发症的主要因素。高度重视术前评估,手术中常规应用脑电图监测、必要时应用临时转流管,严格控制血压,术中、术后严密监护等,有利于减少术后并发症的发生。
Objective To analyze the causes of postoperative complications of carotid endarterectomy and to explore the preventive measures. Methods The clinical data of 99 cases of carotid endarterectomy undergoing carotid endarterectomy were retrospectively analyzed in 99 patients with severe carotid artery stenosis (stenosis rate of 70% -99%). Results There were 1 carotid thrombosis to ischemic stroke, 2 internal carotid artery dissection to ischemic stroke and 2 deaths (1 patient was a 77-year-old with acute myocardial infarction the next day after operation 1 month of death; the other one died of upper gastrointestinal bleeding due to ischemic stroke), 3 cases of cerebral perfusion syndrome and 1 case of hematoma in the operation area. Conclusions Preoperative evaluation, improper operation and judgment, and severe hypertension are the main factors leading to postoperative complications. Attaches great importance to preoperative assessment, routine use of EEG monitoring surgery, if necessary, the application of temporary diversion tube, strict control of blood pressure, intraoperative and postoperative close monitoring, is conducive to reducing the incidence of postoperative complications.