颈动脉内膜剥脱术中脑血流动力学变化的研究  

A Study about the changs of cerebral hemodynamics in carotid endarterectomy

作　　者：张白[1] 惠品晶[1] 黄亚波[2] 汤文宇[3] 吕琦[1] 颜燕红[1] 惠国桢[2] 

机构地区：[1]苏州大学附属第一医院神经外科颈脑血管超声室,215006 [2]苏州大学附属第一医院神经外科,215006 [3]苏州大学附属第一医院麻醉科,215006

出　　处：《中华神经外科杂志》2014年第12期1239-1243,共5页Chinese Journal of Neurosurgery

基　　金：国家重点基础研究发展计划（973计划）（2012eB518106）;江苏省第十批“六大人才高峰”高层次人才选拔培养（WSW-045）;苏州市科技发展计划（SYS201326）;苏州市I临床重点病种诊疗技术专项（LCZX201403）

摘　　要：目的 对颈动脉内膜剥脱术（CEA）中如何防止脑缺血及过度灌注进行前瞻性研究.方法 29例（35例次）接受CEA治疗的颈动脉狭窄患者,分为双侧狭窄组及单侧狭窄组.设定经颅多善勒监测指标以调控血压.临时阻断（以下简称临阻）后,若术侧大脑中动脉平均血流速度（MCAVm）低于临阻前的70％,则提升血压;解除临阻后,若术侧MCA Vm超过临阻前的100％,则降低血压.手术前、后均行血管超声、CT血管造影、CT灌注成像、磁共振成像和（或）数字减影血管造影检查.结果 （1）两组患者：临阻前,术侧MCA Vm较麻醉前下降（P=0.000）;临阻后,MCA Vm略低于临阻前（P＞0.05）,血压升高（23.76±9.15）％（P=0.000）;解除临阻后,MCA Vm较临阻前增加（P =0.000）,血压下降（6.70 ±6.89）％（P=0.000）.（2）两组间比较：临阻后,双侧狭窄组术侧MCA Vm较单侧组减低（P＜0.05）,血压升高幅度较单侧组大（P＜0.01）;解除临阻后,双侧狭窄组血压下降幅度较单侧组小（P＜0.05）,两组间MCA Vm差异无统计学意义（P＞0.05）.（3）预后：患者脑灌注均改善.结论 经颅多善勒在CEA术中实时监测脑血流动力学变化,评估脑灌注,并指导麻醉调控血压,从而预防CEA围手术期脑缺血及过度灌注,提高手术成功率.Objective To study how to prevent cerebral ischemia and hyperperfusion syndrome during carotid endarterectomy （CEA）.Methods Twenty-ninth cases of patients undergoing CEA （35 procedures in total） with carotid artery stenosis were divided into bilateral （group A） and unilateral （group B） stenosis groups.During CEA,the regulation of blood pressure was according to the changes of the ipsilateral middle cerebral artery mean flow velocity （MCA Vm） detected by transcranial Doppler （TCD）：if the MCA Vm after carotid artery occlusion was lower than 70% of that before occlusion,the blood pressure should be increased; and if the MCA Vm after release cross was higher than 100% of that before carotid artery occlusion,the blood pressure should be decreased.All cases in the study were underwent transcranial Doppler,color Doppler flow imaging,CT angiography,CT perfusion imaging,Magnetic resonance imaging,and/or digital subtraction angiography before and after surgery.Results （1） In the two groups：the MCA Vm of the intraoperation side before carotid artery occlusion was decreased as compared with that before anesthesia （P =0.000）.After carotid artery occlusion,the MCA Vm was decreased slightly as compared with that before occlusion （P 〉 0.05）,and the blood pressure was increased （23.76 ±9.15）% （P =0.000） ; The MCA Vm after release cross was higher than that before occlusion（P =0.000）,the blood pressure was decreased （6.70 ±6.89）% （P =0.000）.（2） Between the two groups：After carotid artery occlusion,the MCA Vm of the intraoperation side in group B was decreased than that in group A （P 〈 0.05）.The enhance rate of the blood pressure was higher than that in group A（P 〈0.01）.After release cross,the reduce rate of the blood pressure in group B was lower than that group A （P 〈 0.05）.The MCA Vm between the two groups had no statistic difference （P 〉 0.05）.（3） After surgery,the cerebral perfusion of all patients of the intraoperation side was i

关 键 词：超声检查 多普勒 经颅 颈动脉狭窄 颈动脉内膜剥脱术 脑血流动力学 

分 类 号：R651[医药卫生—外科学]