颈动脉内膜剥脱术后脑过度灌注综合征的危险因素分析  

Risk analysis for cerebral hyperperfusion syndrome after carotid endarterectomy

作　　者：倪冷[1] 刘昌伟[1] 崔丽英 刘暴[1] 叶炜[1] 高山 胡英环 来志超[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院血管外科,100730 [2]神经内科

出　　处：《中华外科杂志》2013年第9期800-803,共4页Chinese Journal of Surgery

基　　金：卫生部中央保健专项资金资助项目（B20098080）

摘　　要：目的分析颈动脉内膜剥脱术（CEA）术后脑过度灌注综合征（CHS）的危险因素。方法回顾性分析2010年9月至2012年9月收治的具备CEA指征的颈动脉狭窄患者183例，其中男性149例，女性34例，年龄38—83岁，平均（664-9）岁。围手术期常规通过经颅多普勒超声监测各时间段脑血流变化，并记录住院期间患者发生CHS的情况。对术前及术中相关因素进行单因素及多因素Logistic回归分析，筛选CEA术后发生CHS的危险因素。结果CEA术后共有15例患者出现CHS，发生率为8．2％，平均发病时间为术后（2．6±0．2）d。单因素分析显示，对术后CHS有影响的因素为既往脑梗死病史、症状性颈动脉狭窄及术中是否转流。Logistic回归分析显示，术后CHS的独立危险因素为症状性颈动脉狭窄（OR=6．733，95％日：1．455—31．155，P=0．015），而术中转流（OR=0．252，95％CI：0．067～0．945，P=0．041）为保护性因素。结论CEA术后发生CHS的独立危险因素为症状性颈动脉狭窄，术中转流为保护性因素。术中转流可能对预防术后CHS有一定效果。Objective To analyze risk factors for cerebral hyperperfusion syndrome （CHS） after carotid endarterectomy （ CEA）. Methods From September 2010 to September 2012, 183 consecutive patients with carotid artery stenosis who bad indications for CEA entered the study. There were 149 male and 34 female patients, aged from 38 to 83 years with an average of （ 66 ± 9 ） years. Intracranial blood flow changes were monitored through transcranial Doppler routinely. Pre- and post-operative middle cerebral artery ve]ocity（ VMCA ） were recorded. CHS was diagnosed by the combination of hyperperfusion syndrome and 100% increase of VMCA after operation compared with pre-operative baseline values. The patients who had CHS during hospitalization were recorded. Pre-operative and operative related factors were analyzed by univariate analysis, followed by Logistic regression model, to identify the risk factors of CHS. Results Overall, CHS occurred in 15 patients （ 8. 2% ） after CEA. The average onset time was （ 2. 6 ±0. 2 ） days after surgery. By decreasing blood pressure and using dehydration medicine, all the patients with CHS recovered before discharge. None of them developed to intracranial hemorrhage. On univariate analysis, significant risk factors for CHS were history of stoke, symptomatic carotid artery stenosis and shunting during operation. On Logistic regression model, independent risk factor was symptomatic carotid artery stenosis （OR = 6. 733, 95% CI： 1. 455-31. 155, P = 0. 015 ）, while shunting during operation （ OR = 0. 252, 95%CI： 0. 067-0. 945, P = 0. 041 ） was a protective factor. Conclusions Symptomatic carotid artery stenosis is an independent risk factor for CHS after CEA and shunting during operation is a protective factor. Using shunt may be an effective method of preventing CHS after CEA.

关 键 词：颈动脉狭窄 颈动脉内膜切除术 血液灌注 超声检查 多普勒 经颅 危险 因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]