术中多模式神经电生理监测联合血压精准控制对颈动脉内膜剥脱术后急性脑梗死发生的影响  

Impact of intraoperative multimodal neurophysiological monitoring combined with blood pressure precision control on incidence of acute cerebral infarction after carotid endarterectomy

作　　者：张洪振 张树新 史红卫 任春圃 刘玉光[4] Zhang Hongzhen;Zhang Shuxin;Shi Hongwei;Ren Chunpu;Liu Yuguang(Department of Vascular Neurosurgery,Dong'e County People's Hospital,Liaocheng 252201,China;Department of Neurology,Dong'e County People's Hospital,Liaocheng 252201,China;Department of Anesthesiology,Dong'e County People's Hospital,Liaocheng 252201,China;Department of Neurosurgery,Qilu Hospital,Shandong University,Ji'nan 250063,China)

机构地区：[1]聊城市东阿县人民医院血管神经外科,聊城252201 [2]聊城市东阿县人民医院神经内科,聊城252201 [3]聊城市东阿县人民医院麻醉科,聊城252201 [4]山东大学齐鲁医院神经外科,济南250063

出　　处：《中华神经医学杂志》2024年第2期174-177,共4页Chinese Journal of Neuromedicine

基　　金：山东省医药卫生科技发展计划项目(202104040257)。

摘　　要：目的探讨术中多模式神经电生理监测联合血压精准控制对颈动脉内膜剥脱术(CEA)后急性脑梗死发生的影响。方法选择自2020年1月至2023年9月聊城市东阿县人民医院血管神经外科收治的305例因颈动脉粥样硬化性狭窄入院并完成CEA的患者为研究对象,其中自2020年1月至2021年12月收治的153例患者应用术中多模式神经电生理监测联合传统经验方式控制血压(对照组),自2022年1月至2023年9月收治的152例患者应用术中多模式神经电生理监测联合基于监测所示的感觉或运动波波幅变化的血压精准控制方式(试验组)。回顾性分析2组患者术后急性脑梗死发生率的差异。结果试验组患者的术后总脑梗死发生率明显低于对照组(4.6%vs.13.0%),差异有统计学意义(P<0.05);其中无症状性脑梗死发生率亦明显低于对照组(3.3%vs 9.8%),差异有统计学意义(P<0.05),而症状性脑梗死发生率的差异无统计学意义(P>0.05)。结论术中多模式神经电生理监测联合血压精准控制能够降低患者CEA后急性脑梗死尤其是无症状性脑梗死的发生,从而有助于提高手术安全性。Objective To investigate the impact of intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control on incidence of acute cerebral infarction after carotid endarterectomy.Methods A retrospective study was peformed;305 patients with atherosclerotic stenosis of the carotid artery admitted to and accepted carotid endarterectomy in Department of Vascular Neurosurgery,Dong'e County People's Hospital from January 2020 to September 2023 were selected.Intraoperative multimodal neurophysiological monitoring combined with traditional empirical modalities for blood pressure control was applied to 153 patients admitted to our hospital from January 2020 to December 2021(control group),and intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control(based on monitored sensory or motor wave amplitude changes)was applied to 152 patients admitted to our hospital from January 2022 to September 2023(experimental group).Difference in postoperative acute cerebral infarction incidence between the 2 groups was compared.Results The experimental group had significantly lower postoperative acute cerebral infarction incidence compared with the control group(4.6%vs.13.0%,P<0.05).The experimental group had significantly lower postoperative asymptomatic acute cerebral infarction incidence compared with the control group(3.3%vs.9.8%,P<0.05),while no significant difference was noted in postoperative symptomatic acute cerebral infarction incidence between the 2 groups(P>0.05).Conclusion Intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control can reduce the postoperative acute cerebral infarction incidence in patients accepted carotid endarterectomy,especacailly postoperative asymptomatic acute cerebral infarction incidence,thereby enhancing surgical safety.

关 键 词：神经电生理监测 血压精准控制 颈动脉内膜剥脱术 急性脑梗死 

分 类 号：R651.12[医药卫生—外科学]