多模态监测在颈动脉内膜剥脱术中的应用  

Application of multimodality monitoring during carotid endarterectomy

作　　者：汤冉冉[1] 李建华 罗坤[1] 郝继恒[2] 张利勇[2] 王继跃[2] Tang Ranran;Li Jianhua;Luo Kun;Hao Jiheng;Zhang Liyong;Wang Jiyue(Department of Neurosurgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi City,Xinjiang Uygur Autonomous Region,830000,China;Department of Neurosurgery,Liaocheng People's Hospital,Liaocheng City,Shandong Province,252000,China)

机构地区：[1]新疆医科大学第一附属医院神经外科,新疆维吾尔自治区乌鲁木齐市830000 [2]聊城市人民医院神经外科,山东省聊城市252000

出　　处：《现代电生理学杂志》2023年第3期139-144,共6页Journal of Modern Electrophysiology

摘　　要：目的探讨颈动脉内膜剥脱术(CEA)中行多模态监测预测术后脑卒中的应用价值。方法回顾性分析聊城市人民医院在2020年1月至2021年12月行CEA手术患者58例,其中男41例,女17例;年龄(65.1±8.7)岁,均经DSA检查证实存在颈动脉狭窄,术中均行多模态神经电生理监测。观察术后疗效及术后并发症,比较术中不同监测模式对于预测术后脑卒中发生的效能。结果患者CEA术后1周内复查CTA或DSA显示颈动脉狭窄均消失。发生围术期卒中患者7例。单一TCD监测的灵敏度为71.43%,高于SEP+MEP监测的57.14%,低于多模态监测的85.71%;SEP+MEP监测的特异度为82.35%,高于单一TCD监测的78.43%,低于多模态监测的92.16%。结论多模态监测在颈动脉内膜剥脱术中有重要意义,可以更好地指导手术进程,评估患者预后。Objective To investigate the application value of multimodal monitoring in predicting postoperative stroke during carotid endarterectomy.Methods A retrospective analysis was performed on 58 patients who underwent CEA surgery in Liaocheng People's Hospital from January 2020 to December 2021,including 41 males and 17 females,age(65.1±8.7)years old.Carotid artery stenosis was confirmed by DSA.Multimodal neuroelectrophysiological monitoring was performed in all patients.The postoperative efficacy and postoperative complications were observed,and the efficacy of different intraoperative monitoring modes in predicting the occurrence of postoperative stroke was compared.Results The patient's follow-up CTA or DSA within one week after CEA showed that the carotid artery stenosis disappeared.There were 7 patients with perioperative stroke.The sensitivity of single TCD monitoring was 71.43%,which was higher than that of SEP+MEP monitoring(57.14%),but lower than that of multimodal monitoring(85.71%).The specificity of SEP+MEP monitoring was 82.35%,higher than that of single TCD monitoring(78.43%)and lower than that of multimodal monitoring(92.16%).Conclusion Multimodal monitoring is of great significance in carotid endarterectomy,which can better guide the operation process and evaluate the prognosis of patients.

关 键 词：颈动脉内膜剥脱术 超声检查 多普勒 经颅 诱发电位 躯体感觉 诱发电位 运动 

分 类 号：R651.12[医药卫生—外科学]