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題名 | 頸動脈內膜切除術對於腦中風預防的研究 |
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作者姓名(中文) | 黃俊一; 李良雄; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 20:1 1987.01[民76.01] |
頁次 | 頁40-52 |
分類號 | 416.291 |
關鍵詞 | 頸動脈內膜切除術; 腦中風預防; |
語文 | 中文(Chinese) |
中文摘要 | 預防由於顱外頸動脈粥狀硬性病變所引起的缺血性腦中風,頸動脈內膜切除手術早已成為安全及有效的治療方法。 榮民總醫院神經外科自民國65年1月到74年12月底,十年間共有84名患者,接受92次頸動脈內膜切除術,男性76名,女性僅有8名,發病年齡介於36歲至71歲之間,平均年齡為57歲, 92次 手術施行於:(1)45例暫時性腦缺血(TIAs)或可復原缺血性神經功能障碍(RIND);(2)2例進行性中風。(3)29例輕度中風,以及(4)16例無症狀頸動脈70%以上狹窄。手術治療的結果大部分有進步或至少手術前的神經症狀沒有改變。手術死亡率為1%,手術後發生嚴重併發症(中風)為2%,追踪期自四個月到十年,平均超過五年,僅有一例在手術後二年發生中風,比例在手術前的症狀為TIAs,因此TIAs的患者手術治療後再發生中風的危險性為2%,吾等發現手術後發生嚴重腦梗塞的併發症其最可能原因為在手術中未注射一大劑量的heparin,自此三例之後,所有的病例在手術中,當血管暫時鋏住之前十分鐘皆例行給heparin,劑量從4,000到5,000單位,手術後不用protamine中和,用此法到目前為止共施行34例,均無再發生手術後腦中風的併發症。我們的結果與國外報告相近,頸動脈內膜切除手術本身並不困難,而且安全,為預防中風最有效的方法。 |
英文摘要 | Carotid endarterectomy has become a standard operative procedure for the prevention of ischemic stroke. From January1976 to December 1985, 92 consecutive carotid endarterectomies in 84 patients were reported at the Veterans General Hospital, Taipei, Republic of China. There were 76 males and 8 females. The ages ranged from 36 to 71, with an average age of 57. The indications for operation in the 92 cases consisted of 45 cases of transient ischemic attacks (TIAs) or reversible ischemic neurological deficit (RIND), 2 cases of progressive stroke, 29 cases of minor stroke, and 16 cases of asymptomatic carotid significant stenosis. The overall postoperative results showed improvement in the great majority of cases or at least the preoperative neurological status remained unchanged. The best outcome was obtained in cases of TIAs/RIND (93% improved). The combined rate of postoperative stroke and death in this series, including two strokes and one death, was 3.3%. The data indicate that patients with selected use of internal shunts during carotid endarterectomy have a more favorable outlook than those with routine use. The intravenous bolus of heparin 10 minutes before carotid cross-cramping was the factor most responsible for preventing the complication of cerebral infarction due to thromboembolism on the operated side. All patients have been folIowed for 4 months to 10 years; only one patient developed minor to moderate stroke 2 years postoperative in the region of the operated carotid artery. Therefore, the risk of future stroke was 2%, according to long-term follow-up on patients with TIAs/RIND. |
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