[1]顾蔚琳,魏善震,陈强,等.经颅多普勒超声在颈动脉内膜剥脱术围手术期的临床应用价值[J].徐州医科大学学报,2020,40(09):676-678.
 Clinical value of transcranial Doppler ultrasound in the perioperative period of carotid endarterectomy[J].Journal of Xuzhou Medical University,2020,40(09):676-678.
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经颅多普勒超声在颈动脉内膜剥脱术围手术期的临床应用价值()
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《徐州医科大学学报》[ISSN:2096-3882/CN:32-1875/R]

卷:
40
期数:
2020年09期
页码:
676-678
栏目:
出版日期:
2020-09-25

文章信息/Info

Title:
Clinical value of transcranial Doppler ultrasound in the perioperative period of carotid endarterectomy
作者:
顾蔚琳魏善震陈强蒋敏
文献标志码:
A
摘要:
目的:探讨经颅多普勒超声(TCD)在颈动脉内膜剥脱术(CEA)围手术期的临床应用价值。方法:选取2015年3月-2019年12月于我院行CEA 治疗的颈动脉狭窄患者32例,由TCD医生对所有患者进行术前评估、术中监测、术后评估,并行计算机体层摄影(CT)及磁共振成像(MRI)判断有无脑实质出血或缺血性改变。结果:术前TCD对颅内交通动脉开放情况评估:23例颈动脉重度狭窄患者中有前交通支和患侧后交通支开放者17例(73.9%),9例颈动脉中度狭窄患者有前交通支和后交通支潜在开放者6例(66.7%)。术中监测:患者临阻前大脑中动脉(MCA)平均血流速(Vm) 较麻醉前下降(P<0.05),临阻后MCA Vm 较麻醉前及临阻前下降(P<0.05),解除临阻后MCA Vm 较麻醉前及临阻前升高(P<0.05);临阻后有创血压较临阻前上升(P<0.05),解除临阻后有创血压较临阻后下降,且低于临阻前(P<0.05);10例患者MCA Vm低于基础值的70%;3例解除阻断后MCA Vm 较临阻前增加超过100%。术后评估及随访:术后患侧的MCA Vm及波动指数(PI)升高(P<0.05),交通动脉关闭。1例患者出现头痛,3例出现烦躁不安。结论:TCD可准确评估术前颅内交通动脉开放情况,术中实时监测脑血流动力学改变,并指导适时调控血压,预防围手术期脑缺血及过度灌注的发生,术后可评估患者脑血流恢复及侧支循环关闭情况,有利于提高手术成功率。
Abstract:
ob<x>jective: To investigate the clinical value of transcranial Doppler (TCD) in the perioperative period of carotid endarterectomy (CEA). Methods: 32 patients treated with CEA ,admitted to our hospital from March 2015 to December 2019,were chosen. Preoperative,intraoperative and postoperative TCD evaluations on these patients were performed. CT and MRI were used to determine whether there was cerebral hemorrhage or ischemia. Results: preoperative evaluation: 17 of 23 patients with severe carotid stenosis (73.9%) had the communicating branch.6 of 9 patients with moderate carotid stenosis (66.7%)had the communicating branch . Intraoperative monitoring: The mean velocity (VM) of MCA before temporary obstruction was lower than that before anesthesia (P < 0.05).The MCA VM after temporary obstruction was lower than that before anesthesia and before temporary obstruction (P < 0.05). The MCA VM after relieving temporary obstruction increased c ompared with that before anesthesia and before temporary obstruction (P < 0.05) .The invasive blood pressure after temporary obstruction was higher than that before temporary obstruction.The invasive blood pressure after relieving temporary obstruction wa s lower than that after temporary obstruction and before temporary obstruction(P < 0.05) .The MCA VM of 10 patients was lower than 70% of the basic value, and the MCA VM of 3 patients increased more than 100% after reliev ing temporary obstruction. Postoperative evaluation and follow-up: The MCA VM and PI of the operative side increased (P < 0.05), and the communicating artery was closed. One patient had headache and three patient s had restlessness. Conclusion: During CEA, TCD can accurately evaluate the opening of intracranial communicating artery before operation, real-time monitor the changes of cerebral hemodynamics during operation, guide to regulate the blood pressure timely, prevent the occurrence of cerebral ischemia and over perfusion in perioperative period, evaluate the recovery of cerebral blood flow and the closure of collateral circulation after operation, so as to improve the success rate of surgery significantly.
更新日期/Last Update: 2020-10-12