颈动脉内膜剥脱术中控制性升压对脑血流的影响  

Influence of Controlled Pressors on Cerebral Blood Flow during Carotid Endarterectomy

作　　者：高振 张晓琳 孟祥宝 GAO Zhen;ZHANG Xiaolin;MENG Xiangbao(Dong'e County People's Hospital,Liaocheng 252200,China)

机构地区：[1]东阿县人民医院,山东聊城252200

出　　处：《中国医药指南》2023年第5期15-18,共4页Guide of China Medicine

摘　　要：目的 探讨颈动脉内膜剥脱术中控制性升压对阻断侧大脑中动脉血流的影响。方法 选取2018年年7月至2020年2月在我院行颈动脉内膜剥脱手术患者,成功行术中脑血流监测82例并统计术前、术中控制血压及脑血流数值。结果 前交通动脉及同侧后交通动脉均开放者23例;仅前交通动脉开放者19例;仅同侧后交通动脉开放者17例;前交通动脉和同侧后交通动脉均不开放者23例。手术过程中阻断后有再次升压过程的患者有33例,再次升压后有14例患者达到脑灌注要求。阻断血流后同侧大脑中动脉血流平均值下降大于40%,且伴有再次升压过程的病例中,有交通动脉开放平均动脉血压再次升高百分比(16.94±5.02)%,平均血流流速再次升高范围百分比(14.75±5.89)%;无交通动脉开放平均动脉血压再次升高百分比(13.65±3.69)%,平均血流流速再次升高百分比(1.35±1.45)%。在再次升压过程中,有交通动脉开放与无交通动脉开放的病例随升压幅度的变化,流速变化差异有统计学意义,P<0.05。结论 手术阻断血流过程中升高血压对无交通动脉开放患者的同侧大脑中动脉流速提升无明显作用,而对仅存在后交通动脉开放患者的流速提升作用明显。Objective To investigate the effect of controlled pressure boost on the blood flow of blocked side middle cerebral artery during carotid endarterectomy. Methods A total of 82 patients who underwent carotid endarterectomy in our hospital from July 2018 to February 2020 were selected, and the intraoperative cerebral blood flow monitoring was performed successfully. Preoperative and intraoperative blood pressure control and cerebral blood flow were calculated. Results Both anterior and posterior ipsilateral arteries were open in 23 cases. Only the anterior traffic artery was open in 19 cases. Only 17 patients had ipsilateral posterior traffic artery open. Both anterior and ipsilateral posterior arteries were closed in 23 cases. During the operation, 33 patients underwent re-elevation after occlusion, and 14 patients achieved cerebral perfusion requirements after re-elevation. After blood flow occlusion, the mean blood flow of the ipilateral middle cerebral artery decreased by more than 40%, and in the cases accompanied by the process of re-elevation, the mean blood pressure of the open traffic artery increased again(16.94±5.02)%, and the mean blood flow velocity increased again(14.75±5.89)%. The mean arterial blood pressure increased again(13.65±3.69)% and the mean blood flow velocity increased again(1.35±1.45)%. In the process of re-boosting, there was a significant difference between the cases with and without open traffic arteries with the change of pressure boost amplitude and the change of flow velocity, P<0.05. Conclusion The increase of blood pressure during surgical occlusion of blood flow has no significant effect on the increase of ipsilateral middle cerebral artery flow rate in patients with no open traffic artery, but has significant effect on the increase of flow rate in patients with only open posterior traffic artery.

关 键 词：颈动脉内膜剥脱术 经颅彩色多普勒超声 脑血流 血压 交通动脉 

分 类 号：R322.1[医药卫生—人体解剖和组织胚胎学]