颈动脉支架成形术后高灌注综合征的原因和防治  

Prevention and treatment of hyperperfusion syndrome following carotid artery stenting

作　　者：张薇[1] 张临洪[1] 徐武平 旃培艳[1] 

机构地区：[1]武汉市中心医院神经内科,湖北武汉430014

出　　处：《中风与神经疾病杂志》2011年第5期407-410,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨颈动脉支架成形术(CAS)后发生高灌注综合征(HPS)的原因、预防及处理措施。方法回顾性分析98例CAS后5例出现HPS患者的临床资料,总结发生HPS的原因和防治措施。结果 98例患者术前颈动脉狭窄率为75%~98%,平均89%。HPS发生率为5.1%,术后20m in^5d(平均2.5h)出现头痛(100%),其中伴发呕吐3例(60%),高血压3例(60%),局灶性神经功能缺损2例(40%),局限性癫痫发作1例(20%)和意识障碍1例(20%)。经颅多普勒超声证实5例患者支架同侧大脑中动脉的峰血流速度均增加100%以上(100%),CT提示颅内出血2例(40%),脑组织水肿2例(40%),无明显变化1例(20%)。经脱水、降压等治疗后3例完全恢复,2例部分恢复,无死亡病例。结论 HPS是CAS后少见但严重的并发症,术前评估患者是否有高灌注危险因素,术中、术后经颅多普勒超声监测及控制血压,及时诊断并采取有效措施能有效预防和处理HPS。Objective To explore the etiology,prevention and treatment of hyperperfusion syndrome（HPS）following carotid artery Stenting（CAS）.Methods The clinical data of 5 patients with HPS from 98 cases of carotid artery stenting were reviewed retrospectively,and etiology and treatment methods of HPS were summarized.Results The diameter narrowing of 98 patients was in a range of 75%～98%（mean 89%）.Five patients（5.1%）developed HPS following stenting.Symptoms developed within a median of 2.5h（20min～5d）following the procedure.All five（100%）patients had headache,among them,three（60%）developed vomiting,three（60%）hypertension,two（40%）focal neurologic impairment,one（20%）local epilepsy motor seizure,one（20%）disorder of consciousness,two（40%）brain edema,two（40%）intracranial hemorrhage measured by CT,and one（20%）no change.Measured by transcranial doppler（TCD）,the peak velocity of the ipsilateral middle cerebral artery increased in all patients with HPS（100%）.After all five patients were given the therapy of dehydration and antihypertention,three of the five achieved full recovery,two partially recoverd and no death occurred.Conclusion The hyperperfusion syndrome occurs infrequently following CAS,and is a serious complication.The preoperative evaluation of high risk of HPS,intraoperative and postoperative TCD measurment and blood pressure control,and timely diagnosis and treament are effective to prevent or reduce the risk of HPS.

关 键 词：颈动脉狭窄 支架 高灌注综合征 

分 类 号：R743[医药卫生—神经病学与精神病学]