经颅多普勒超声对颈动脉内膜剥脱术围手术期脑血流的评估与应用  

The Application and Evaluation of Transcranial Doppler Ultrasonography for Carotid Endarterectomy in Perioperative Period

作　　者：陈景云[1] 张晨[1] 潘宗[1] 董亮艳[1] 吴艳华[1] 王伟[2] 刘文庆[2] 

机构地区：[1]宁夏医科大学总医院心脑血管病医院神经电生理室,银川750002 [2]宁夏医科大学总医院心脑血管病医院神经外科,银川750002

出　　处：《宁夏医科大学学报》2016年第10期-,共6页Journal of Ningxia Medical University

摘　　要：目的探讨应用经颅多普勒超声(TCD)在颈动脉内膜剥脱术(CEA)围手术期中对脑动脉常规检查及术中监测脑血流动力学改变的意义。方法对26例神经外科CEA患者根据交通动脉情况分成4组:开放组、不开放组、潜在开放组和无潜在开放组,进行术前TCD检测,术中TCD监测及术后TCD复查。对术前压颈试验与术中实验性夹闭颈总动脉(CCA)不同时间各组大脑中动脉(MCA)的收缩期峰值血流速度(PSV)进行配对t检验。结果 1术前TCD对颅内交通动脉开放情况进行评估:19例颈动脉重度狭窄患者中有交通支开放的14例(73.6%),无交通支开放的5例(26.3%);7例颈动脉中度狭窄患者中交通支潜在开放的5例(71.4%),无交通支潜在开放的2例(28.6%)。2术中不使用转流的TCD血流动力学评估:26例患者压颈即刻与压颈后1min、夹闭CCA即刻与夹闭CCA后3min比较,MCA的PSV均出现血流速度回升(P<0.05)。3术中脑血流过度灌注的TCD评估:7例患者在剥脱手术完成并开放夹闭的CCA时,术侧MCA的PSV出现明显增快,采取半夹闭CCA并断续开放,同时降低患者血压,MCA的PSV降低。4术后TCD复查及随访:26例CEA患者术后TCD显示颅内血流明显改善的17例,术前所有开放的前、后交通支关闭。26例患者术后随访均未出现明显的临床症状。结论应用TCD对CEA患者围手术期进行监测,可评估术前侧支开放情况、术中血流动力学变化及术后手术效果,减少手术并发症;术中不使用转流术,也可获得良好手术效果。Objective To investigate the significance and value of transcranial doppler ultrasonography(TCD)for routine examination of cerebral aerery and monitoring cerebral hemodynamic changes in perioperative period of carotid endarterectomy(CEA).Methods According to the opening and not opening of the situation of the traffic artery,all 26 patients preparing for CEA were divided into four groups:the traffic artery opening group,no opening group,potential opening group and no potential opening group.All of them were done TCD examination before operation,during operation for monitoring and reexamination after operation.Matched test was performed on the systolic peak flow velocity(PSV)between pressing neck test before operation and experimental cliping common carotid artery(CCA)during operation at different time of the middle cerebral artery(MCA).Results 1Evaluation for intracranial traffic artery opening situation:14 cases(73.6%)of 19 patients with severe stenosis of carotid artery had opening traffic artery,5 cases(26.3%)had no opening traffic artery;5 cases(71.4%)of 7 patients with moderate stenosis of carotid artery had potential opening traffic artery,2 cases(28.6%)had no potential opening traffic artery.2Hemodynamic changs in patients without using shunt during operation showed:compared pressing neck immediately with after 1min while compared clipping CCA immediately with after 3min,the PSV of MCA appeared rebound phenomenon for all 26 cases(P< 0.05).3Hyperperfusion of brain blood flow showed:PSV of intraoperative bilateral MCA significantly increased in 7 cases after operation and opening CCA which clipped.Half-clipping CCA and intermittent opening CCA,at the same time,reduced the patients' blood pressure and the PSV of MCA.4Postoperative TCD review and follow-up:17 cases of 26 patients after CEA showed significant improvement of intracranial blood flow in TCD examination.The anterior and arteriae communicating artery which opened before operation closed.26 patients with postoperative follow-up did not appear obvious

关 键 词：经颅多普勒超声 脑血流动力学 颈动脉内膜剥脱术 

分 类 号：R651.12[医药卫生—外科学]