颈动脉预阻断与逆流压测定在内膜剥脱术中的应用  

Pre-occlusion and Stump Pressure of the Internal Carotid Artery in Carotid Endarterectomy

作　　者：翟国钧[1] 赵军[1] 董国祥[1] 

机构地区：[1]北京大学第三医院介入血管外科,北京100191

出　　处：《中国微创外科杂志》2009年第12期1126-1128,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨颈动脉预阻断试验与逆流压测定在颈动脉内膜剥脱术中的应用价值。方法2007年1月～2009年1月,对12例颈动脉狭窄者,在颈丛麻醉下完成颈动脉内膜剥脱术,术中行颈动脉预阻断试验并测定颈内动脉逆流压,选择性应用转流管,清醒状态下全术程监测。观察术中、术后并发症,记录、分析颈内动脉逆流压及预阻断试验,评价近期随访结果。结果术中3例一过性心率、血压升高,颈内动脉逆流压2例最低值出现于对侧颈动脉中重度狭窄且伴椎动脉病变的患者,预阻断试验(+)者2例,选择性应用转流管4例,术后高灌注综合征1例。术前伴有头晕及视力下降的9例症状均改善。术后随访平均11个月(1～26个月),2例再狭窄,无脑梗死发生。结论颈丛麻醉结合预阻断试验为颈动脉内膜剥脱术提供了微创、安全、有效的监测,建议结合预阻断试验、颈内动脉逆流压及对侧颈动脉、椎基底动脉病变程度选择性应用转流管。Objective To investigate the value of the pre-occusion and stump pressure（SP）of the internal carotid artery in carotid endarterectomy（CEA）.Methods During Januray 2007 to January 2009,12 patients with carotid arterial stenosis underwent CEA in our deparment.With cervical plexus block,we performed pre-occlusion test and measured the stump pressure（SP）by using vascular shunt selectively.The patients were monitored with clear consciousness during the whole procedure of CEA.The data of postoperative complications and results of pre-occlusion and SP as well as the follow-up were analyzed afterwards.Results During the operaion,three patients had transient increase of heart rate and blood pressure.The lowest SP was detected in two patients,who had moderate or severe stenosis of the contralateral carotid artery complicated with lesions in the vertebral basilar artery.Two patients showed positive results in pre-occusion test,and vascular shunt was used in four cases.After the operaion,one patients developed hyperperfusion syndrome.Nine patients showed improvement of symptoms of dizziness and decreased eyesight.This series were followed up for a mean of 11 months（ranged from 1 to 26 months）.During the period,two of the patients showed re-stenosis of the carotid artery;none of them had cerebral infarction.Conclusions Cervical plexus block combined with pre-occusion test ensures the safty and effectiveness of minimally invasive carotid endarterectomy.We recommend selective vascular shunt according to the results of pre-occlusion test,SP,and the severity of the lesions in the contralateral carotid artery and vertebral basilar artery.

关 键 词：颈动脉 逆流压 内膜剥脱术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]