颈动脉内膜切除术中监测指标间的相关性研究  

Correlational study monitoring parameters during carotid endarterectomy

作　　者：佟志勇[1] 刘源[1] 王刚[1] 金友贺[2] 张劲松[2] 胡海军[1] 李啸[1] 齐石磊 梁传声[1] 王运杰[1] 

机构地区：[1]中国医科大学附属第一医院神经外科,沈阳110001 [2]中国医科大学附属第一医院心血管超声科,沈阳110001

出　　处：《中国微侵袭神经外科杂志》2016年第5期196-198,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：沈阳市科学技术项目计划(编号:F13-316-1-55)

摘　　要：目的探讨颈动脉内膜切除术(CEA)中,经颅多普勒超声(TCD)和残端压监测,能否等效判断是否需要使用转流。方法回顾性分析63例全身麻醉下行CEA的病例资料,术中根据TCD监测指标决定是否使用转流,同时监测残端压。结果术中临时阻断颈动脉后,14例(22.2%)病人大脑中动脉平均血流速度(MCAVm)下降幅度>50%,需使用转流;35例(55.6%)病人残端压<40 mm Hg。在使用转流的病例中,阻断颈动脉后MCAVm和基础值的比例,与残端压之间存在线性关系(r^2=0.41,F=0.014,P=0.014)。结论 CEA术中TCD和残端压监测对于判断是否需要使用转流的符合率较低。残端压不能替代TCD作为判定CEA术中是否应该使用转流的监测方法。Objective To compare the efficacy of transcranial doppler（TCD） and stump pressure（SP） monitoring as an optimal method for determining the need for selective shunting during carotid endarterectomy（CEA）. Methods The clinical data of 63 patients receiving CEA were analyzed retrospectively. SP and middle cerebral artery mean flow velocity（MCAVm） were performed by TCD monitoring in all the patients. Shunting was performed on the basis of TCD monitoring. Results After carotid temporary occlusion, shunt was used decrease of MCAVm by 〉50% in 14（22.2%） cases. SP was less than 40 mm Hg in 35（55.6%） cases. There was a linear relationship between SP and the post-CEA MCAVm/basal value ratio in patients receiving shunt（r^2= 0.41, F = 0.014, P = 0.014）. Conclusions The accordance rate between TCD and SP monitoring is low in assessing whether shunt is needed or not during CEA. SP could not replace TCD monitoring as an optimal method for determining the need for selective shunting during CEA.

关 键 词：颈动脉内膜切除术 超声检查 多普勒 经颅 残端压 转流 

分 类 号：R653[医药卫生—外科学]