经颅多普勒超声监测指导颈动脉内膜剥脱术中选择性应用转流管的单中心研究  

Transcranial Doppler ultrasound monitoring in guiding the selective use of shunts during carotid endarterectomy:A single-center study

作　　者：武森森 高喜翔[1] 张楠[2] 张帆[1] 郭聚龙 崔世军[1] 佟铸[1] 郭建明[1] 邢英琦[2] 谷涌泉[1] 郭连瑞[1] Wu Sensen;Gao Xixiang;Zhang Nan;Zhang Fan;Guo Julong;Cui Shijun;Tong Zhu;Guo Jianming;Xing Yingqi;Gu Yongquan;Guo Lianrui(Department of Vascular Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Vascular Ultrasound,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管外科,北京100053 [2]首都医科大学宣武医院血管超声科,北京100053

出　　处：《中国血管外科杂志（电子版）》2024年第1期51-55,63,共6页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：国家重点研发计划(2022YFC3602400,2022YFC360404)。

摘　　要：目的探讨经颅多普勒超声(transcranial Doppler ultrasound,TCD)监测在指导颈动脉内膜剥脱术(carotid endarterectomy,CEA)术中选择性使用转流管的价值。方法回顾性分析2018年7月至2023年12月在首都医科大学宣武医院血管外科行CEA治疗的321例颈动脉狭窄患者(330例次手术)的临床数据,根据术前TCD评估将患者分为无需转流组(157例次)、可能需要转流组(92例次)和必需转流组(81例次)。评估TCD术前评估及术中监测在CEA的应用价值。结果共75例次(22.73%)使用转流管。症状性脑梗发生率为1.52%,其中转流患者为5.33%,未转流患者为0.39%。无需转流组、可能需要转流组和必需转流组分别有3.2%、15.2%和69.1%的患者进行转流操作,症状性脑梗死的发生率分别为0.64%、2.06%和2.47%,差异无统计学意义(P=0.455)。结论TCD术中监测能安全、有效地指导CEA选择性使用转流管;术前评估对于术中精准转流有较高的指导价值,但术中实时监测仍是必要的。Objective To investigate the value of transcranial Doppler ultrasound(TCD)monitoring in guiding the selective use of shunts during carotid endarterectomy(CEA).Methods The clinical data of 321 patients with carotid stenosis who underwent CEA(330 times)in Department of Vascular Surgery,Xuanwu Hospital,Capital Medical University from July 2018 to December 2023 was analyzed retrospectively.Based on preoperative TCD assessment,patients were divided into no shunt required group(157 times),possible shunt required group(92 times),and shunt definitely required group(81 times).The application value of preoperative TCD assessment and intraoperative monitoring in CEA surgery was evaluated.Results A total of 75 shunts(22.73%)were used.The incidence of symptomatic cerebral infarction was 1.52%,with a rate of 5.33%in the shunt cases and 0.39%in the non-shunt cases.The ratio of patients who underwent shunt procedures in the no shunt required group,possible shunt required group and shunt definitely required group was 3.2%,15.2%and 69.1%,respectively,and the incidence of symptomatic stroke in the three groups was 0.64%,2.06%and 2.47%,respectively,with no statistically significant difference(P=0.455).Conclusion TCD intraoperative monitoring can safely and effectively guide the selective use of shunts during CEA surgery.Preoperative assessment has some guiding value for precise intraoperative shunt placement,but real-time intraoperative monitoring remains essential.

关 键 词：颈动脉狭窄 颈动脉内膜切除术 经颅多普勒超声 转流 

分 类 号：R654.3[医药卫生—外科学]