血管超声对颈动脉内膜剥脱术中血管结构变化及血流动力学的评估  

Evaluation of Hemodynamics and Vascular Construction changes During Carotid Endarterectomy Using vascular ultrasonography

作　　者：刘玉梅[1] 华扬[1] 刘蓓蓓[1] 孟秀峰[1] 杨洁[1] 贾凌云[1] 

机构地区：[1]首都医科大学宣武医院血管超声科,北京市100053

出　　处：《中国超声医学杂志》2010年第11期1001-1004,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的分析彩色多普勒血流成像(CDFI)与经颅多普勒(TCD)超声联合应用,在颈动脉内膜剥脱术(carotid endarterectomy,CEA)中对局部动脉形态结构和颅内大脑中动脉(MCA)、颅外颈动脉血流动力学变化的监测,综合评估该检查技术对提高CEA成功率的实用价值。方法选择行CEA的患者136例,术中通过对颈动脉管径、收缩期峰值及舒张末期血流流速(PSV和EDV)的测量,记录残余狭窄的发生率和检测术中二次手术剥脱前后局部PSV、EDV及颅内MCA血流动力学参数的变化。结果对136例患者实施了CEA术。根据Panneton术中超声分类标准,将本组CEA术中CDFI结果分类为正常组86例,轻度异常组(25例),显著异常组(25例)。显著异常组中16例(64%)进行术中二次剥脱。所有患者围手术期脑卒中发生率为5.9%。术中CDFI发现残余血管狭窄大于50%者为17.6%(24例),狭窄处管径(2.1±1.5)mm,较无残余狭窄者(3.9±1.1)mm明显减小(P=0.000),狭窄段PSV及EDV均明显升高(P=0.000,P=0.000)。16例患者经二次手术剥脱后管径明显增宽(P=0.000),狭窄段PSV明显改善(P=0.000)。术中二次剥脱患者的残余管径均≤2mm,PSV>245cm/s,患侧MCA的PSV及EDV由(47.1±16.7)cm/s和(24.2±9.0)cm/s提高(75.4±34.2)cm/s和(37.0±20.1)cm/s(P=0.000、P=0.001)。结论 CDFI与TCD技术联合,可以客观评估CEA术中颈动脉及患侧MCA血管结构及血流动力学变化,即时指导术者实施二次剥脱,减少术中残余狭窄的发生率,提高CEA的成功率。Objective The purpose of this study is to evaluate the morphologic of internal carotid artery （ICA） and hemodynamic changes of middle cerebral artery （MCA） during carotid endartereetomy （CEA） by combined intraoperative color duplex flow imaging（CDFI） with transcranial Doppler （TCD）. Methods A retrospective study was performed on 136 cases with CEA from January 2004 to November 2009 in Xuanwu hospital. The lumen diameters of ICA and peak systolic velocity（PSV）, end diastolic velocity（EDV）in carotid arteries were measured and compared before surgery and intraoperation. The incidence rate of residual stenosis and the hemodynamic changes of MCA were also analyzed. Results All patients were grouped into three categories depended on the Panneton＇s standard and results of CD- FI. 86 cases were normal;mild and insignificant abnormal were 25 cases respectively. The residual stenosis greater than 500//00 oecured 17.6%（24/136 cases）, in which 64% patients （16/24 cases ） have been underwent immediate surgical revision. Both diameter and PSV were improved instantly after revising. The incidence rate of perioperative ipsilateral strokes was 5.9%. Meanwhile, the PSV and EDV of ipsilateral MCA were increased from 47.1 ± 16.7cm/s and 24.2 ± 9.0cm/s to 75.44±34.2cm/s and 37.0±20. lcm/s respectively（P=0. 000,P=0. 001）. The result of our study shows that when the diameter≤2mm,PSV 〉 245cm/s,an immediate surgical revision would be required. Conclusions CDFI combined with TCD is a safe and effective method to evaluate the morphologic and hemodynamic changes of ICA and MCA during CEA. The abnormal finding intraoperation and immediate repair of significant technical defects may de crease the rate of residual stenosis and rising success rate of CEA.

关 键 词：颈动脉内膜剥脱术 监测 彩色多普勒超声 经颅多普勒超声 

分 类 号：R651.12[医药卫生—外科学] R445.1[医药卫生—临床医学]