全麻下颈动脉重度狭窄介入治疗预防脑过度灌注综合征发生的研究  

Study of interventional therapy in patients with severe carotid artery stenosis under general anesthesia to prevent cerebral hyperperfusion syndrome

作　　者：邢国平[1] 钟池[1] 许晓伟[1] 王安宁[1] 刘桂杰[2] 李伟[3] 

机构地区：[1]潍坊市人民医院神经内科,261041 [2]潍坊市人民医院放射科,261041 [3]潍坊市人民医院麻醉科,261041

出　　处：《临床神经病学杂志》2014年第6期405-408,共4页Journal of Clinical Neurology

基　　金：山东省优秀中青年科学家科研奖励基金(BS2012YY035);潍坊市科学技术发展计划项目(2013FZA00090)

摘　　要：目的探讨全麻对颈动脉重度狭窄支架置入术后过度灌注综合征发生的预防作用。方法选择单侧颈动脉起始段重度狭窄患者92例行颈动脉支架置入术,根据麻醉方式分为局麻组39例和全麻组53例。记录平均手术时间、平均住院时间、术中并发症发生率、术中收缩压标准差及血压变异系数、术后5 d内并发症发生率、术后3个月卒中发生率以及术后脑过度灌注综合征发生率。结果两组间平均住院时间、术中并发症发生率、术后5 d内并发症发生率、术后3个月卒中发生率差异无统计学意义(均P>0.05)。全麻组平均手术时间延长(P<0.05)。全麻组收缩压标准差[(11.77±1.74)mm Hg]小于局麻组[(17.35±3.39)mm Hg](P<0.001),全麻组收缩压变异系数[(10.71±1.05)%]小于局麻组[(12.68±2.35)%](P<0.001)。局麻组术后发生脑过度灌注综合征5例,全麻组发生脑过度灌注综合征1例,两组发生率差异具有统计学意义(P=0.047)。结论全麻可降低重度单侧颈动脉狭窄患者支架置入术后过度灌注综合征的发生率,其机制可能在于全麻可以更好的控制术中血压。Objective To investigate the preventive effects of general anesthesia on cerebral hyperperfusion syndrome after carotid artery stenting （CAS）. Methods Carotid artery stenting were performed in 92 patients with unilateral severe carotid artery stenosis. Patients were divided into local anesthesia group （ n = 39 ） and general anesthesia group （ n = 53 ）. To observe the incidence of the average operation time, average stay, incidence rate of intraoperative complications, standard deviation and variability of systolic blood pressure in operation, incidence rate of postoperative complications within 5 d, the incidence of stroke within 3 months and the incidence rate of cerebral hyperperfusion syndrome. Results No significant statistical differences were seen in average stay, incidence rate of intraoperative complications, incidence rate of postoperative complications within 5 d, incidence of stroke within 3 months between the two groups （ all P 〉 0. 05 ）. The average operation time was longer in general anesthesia group than in local anesthesia group （ P 〈 0. 05 ）. Standard deviation of systolic blood pressure in general anesthesia [ （11.77±1.74 mmHg） ~was smaller than that in local anesthesia group [ （17. 35 ± 3. 39）mmHg ] （P〈 0. 001 ）. The variability of systolic blood pressure in general anesthesia [ （ 10.71 ±1.05） % ] was smaller than that in local anesthesia group [ （ 12.68 ± 2.35 ） % ] （P 〈 0. 001 ）. Five cases of cerebral hyperperfusion syndrome happened in local anesthesia group, while one case in general anesthesia group. There was significant statistical difference between the incidence of two groups （ P = 0. 047 ）. Conclusion General anesthesia can reduced the incidence rate of cerebral hyperperfusion syndrome after CAS in patients with unilateral severe carotid stenosis, its mechanism probably partly lied on better control of intraoperative blood pressure.

关 键 词：颈动脉狭窄 颈动脉支架置入术 脑过度灌注综合征 麻醉方法 

分 类 号：R743.3[医药卫生—神经病学与精神病学]