Treiman R L, Cossman D V, Foran R F, Levin P M, Cohen J L, Wagner W H
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
J Vasc Surg. 1990 Oct;12(4):440-5; discussion 445-6.
The influence of neutralizing or not neutralizing heparin after carotid endarterectomy on postoperative stroke and wound hematoma is unknown. During the past 6 years some of the authors frequently gave protamine sulfate to neutralize heparin, whereas others did not unless a patch was used or wound hemostasis was not readily obtained. To determine the influence of protamine sulfate on stroke and wound hematoma the records of 697 patients having a carotid endarterectomy from January 1984 to September 1989 were reviewed. Protamine sulfate was given to 328 patients, and 369 did not receive protamine sulfate. The incidence of stroke in the two groups was 1.8% (n = 6) and 2.7% (n = 10), respectively, and the difference was not significant (p = 0.6019). Excluding three strokes that could not be related to neutralizing or not neutralizing heparin, the difference remained insignificant (1.5% vs 2.2%, p = 0.7290). The incidence of wound hematoma was 1.8% (n = 6) in patients given protamine sulfate and 6.5% (n = 24) in patients not given protamine sulfate, and this difference was significant (p = 0.0044). The difference remained significant when three hematomas not related to protamine sulfate were excluded (1.2% vs 6.2%, p = 0.0013). In patients not given protamine sulfate draining the wound lessened the incidence of wound hematoma (4.4% vs 8.6%), but this difference was not statistically significant (p = 0.1475). In patients given protamine sulfate the dose of protamine sulfate (15 to 45 mg vs 50 to 75 mg) had no statistically significant effect on the incidence of stroke (0.8% vs 2.0%, p = 0.6530) or wound hematoma (1.6% vs 1.0%, p = 1.000).
颈动脉内膜切除术后中和或不中和肝素对术后中风和伤口血肿的影响尚不清楚。在过去6年中，部分作者经常使用硫酸鱼精蛋白中和肝素，而其他作者则除非使用补片或难以实现伤口止血，否则不使用硫酸鱼精蛋白。为了确定硫酸鱼精蛋白对中风和伤口血肿的影响，回顾了1984年1月至1989年9月期间697例行颈动脉内膜切除术患者的记录。328例患者使用了硫酸鱼精蛋白，369例未使用硫酸鱼精蛋白。两组中风发生率分别为1.8%（n = 6）和2.7%（n = 10），差异无统计学意义（p = 0.6019）。排除3例与中和或不中和肝素无关的中风后，差异仍无统计学意义（1.5%对2.2%，p = 0.7290）。使用硫酸鱼精蛋白的患者伤口血肿发生率为1.8%（n = 6），未使用硫酸鱼精蛋白的患者为6.5%（n = 24），差异有统计学意义（p = 0.0044）。排除3例与硫酸鱼精蛋白无关的血肿后，差异仍有统计学意义（1.2%对6.2%，p = 0.0013）。在未使用硫酸鱼精蛋白的患者中，伤口引流可降低伤口血肿发生率（4.4%对8.6%），但差异无统计学意义（p = 0.1475）。在使用硫酸鱼精蛋白的患者中，硫酸鱼精蛋白剂量（15至45 mg对50至75 mg）对中风发生率（0.8%对2.0%，p = 0.6530）或伤口血肿发生率（1.6%对1.0%，p = 1.000）无统计学显著影响。
