多参数监测在颈动脉内膜剥脱术治疗合并对侧颈动脉中重度狭窄中的应用  

Application of multi-parameter monitoring in carotid endarterectomy for moderate and severe contralateral carotid artery stenosis

作　　者：闫宏旭 安乾[1] 王梦宇 胡昕涛 殷向阳 王兵[1] Yan Hongxu;An Qian;Wang Mengyu;Hu Xintao;Yin Xiangyang;Wang Bing(Department of Vascular Surgery,The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院血管外科,河南郑州450052

出　　处：《中国血管外科杂志（电子版）》2024年第1期56-59,共4页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的探索残端压(stump pressure,SP)、术中体感诱发电位(somatosensory evoked potential,SEP)、脑电图(electroencephalogram,EEG)和经颅多普勒超声(transcranial Doppler,TCD)监测在颈动脉内膜剥脱术(carotid endarterectomy,CEA)治疗合并对侧颈动脉中重度狭窄患者的应用和意义。方法回顾性分析2021年5月至2023年6月郑州大学第五附属医院26例行CEA治疗合并对侧颈动脉中重度狭窄患者的临床资料,患者术中均行SEP、EEG、SP和TCD监测并设定预警标准,记录围手术期并发症发生情况及改良Rankin量表(modified Rankin scale,mRS)评分。结果26例患者发生多参数监测预警34次,其中SEP预警7次、EEG预警8次、SP预警10次、TCD预警9次。3例患者在升压后未解除预警而使用转流管。术后发生症状性脑梗死1例,过度灌注综合征2例,颅神经损伤1例。术后3个月复查影像学显示术侧颈动脉均通畅,均无新发脑血管事件和死亡。患者术后mRS评分0分21例,1分4例,2分1例。结论对于合并对侧颈动脉中重度狭窄的患者,CEA术中多参数监测可更准确地评估术中脑血流状态,指导转流管的合理使用,减少围手术期并发症的发生。Objective To explore the application and significance of stump pressure(SP),somatosensory evoked potential(SEP),electroencephalogram(EEG)and transcranial Doppler(TCD)monitoring during carotid endarterectomy(CEA)in patients with moderate to severe stenosis of the contralateral carotid artery.Methods The clinical data of 26 patients with moderate to severe stenosis of the contralateral carotid artery who underwent CEA at the Fifth Affiliated Hospital of Zhengzhou University from May 2021 to June 2023 were analyzed retrospectively.All patients underwent SEP,EEG,SP and TCD monitoring during the operation.Early warning standards were set,and perioperative complications and modified Rankin scale(mRS)scores were recorded.Results There were 34 multi-parameter monitoring warnings in 26 patients,including 7 SEP warnings,8 EEG warnings,10 SP warnings and 9 TCD warnings.Three patients did not clear the warning after increasing pressure and used shunts.One case of symptomatic cerebral infarction,2 cases of hyperperfusion syndrome and 1 case of cranial nerve injury occurred postoperatively.The follow-up imaging 3 months after the operation showed that that the carotid artery on the surgical side was unobstructed,and there were no new cerebrovascular events or deaths.The postoperative mRS score of the patients was 0 point in 21 cases,1 point in 4 cases,and 2 points in 1 case.Conclusion For patients with moderate to severe stenosis of the contralateral carotid artery,multi-parameter monitoring during CEA can accurately evaluate the intraoperative cerebral blood flow status,guide the rational use of shunt tubes and reduce the occurrence of perioperative complications.

关 键 词：颈动脉狭窄 颈动脉内膜剥脱术 残端压 体感诱发电位 脑电图 经颅多普勒超声 转流 

分 类 号：R743.3[医药卫生—神经病学与精神病学]