摘要
目的 探讨脑颈动脉超声一体化在颈动脉内膜切除术(carotid endarterectomy,CEA)围手术期的应用价值。方法 回顾性分析接受CEA的颈动脉狭窄患者166例的临床资料,术前除了行脑血管造影(digital subtraction angiography,DSA)和(或)CT血管成像(computed tomography angiography,CTA)外,所有患者均行颈动脉彩色多普勒超声(以下简称:颈动脉超声)评估颈动脉狭窄和斑块特点,经颅彩色多普勒超声(transcranial color-coded duplex,TCCD)或经颅多普勒超声(transcranial Doppler,TCD)判断颅内外血管侧支代偿情况,术中应用TCD监测双侧大脑中动脉(middle cerebral artery,MCA)收缩期峰值流速(peak systolic velocity,PSV),根据PSV进行个体化血压调控,决定是否使用颈动脉转流管,防止出现脑过度灌注综合征,术后通过脑颈动脉超声一体化进行复查及随访,评价术后效果。结果 所有患者颈动脉狭窄和侧支循环情况通过脑颈动脉超声一体化诊断评估,其中颈内动脉次全闭塞者8例、狭窄率(stenosis,ST)为50%~69%且具有临床症状者15例、ST为70%~99%者136例(其中支架内再狭窄且ST为70%~99%者4例)、颈动脉蹼6例;前交通动脉开放27例、后交通动脉开放38例、前+后交通动脉开放13例、颈内、外动脉侧支开放42例、无侧支开放9例,与DSA或CTA结果高度一致。术中采取颈动脉转流24例,未转流者术后出现轻度脑过度灌注综合征6例,轻微脑梗死1例,均恢复良好。术后7 d内死亡2例(心肌梗死1例、突发心脏骤停1例)、1例颈内动脉闭塞(颈动脉重度狭窄伴颅外段颈内动脉动脉瘤实施颈内动脉结扎),余163例术后6个月复查颈内动脉通畅。结论 术前经脑颈动脉超声一体化评估颈动脉狭窄程度及侧支循环开放情况与DSA高度一致,在CEA术前、术中、术后能够提供可靠的信息,提高手术安全性,在CEA围手术期具有重要的应用价值。
Objective To investigate the value of integrated carotid ultrasonography and transcranial Doppler(TCD)in perioperative period of carotid endarterectomy(CEA).Methods The clinical data of 166 patients who received CEA due to carotid stenosis were retrospectively analyzed.In addition to digital subtraction angiography(DSA)and/or computed tomography angiography(CTA),carotid artery color Doppler ultrasound(referred to as carotid artery ultrasound)was also conducted to evaluate carotid artery stenosis and characteristics of plaques.Transcranial color-coded Duplex(TCCD)and TCD were carried out to determine the compensatory status of collateral circulation of the brain.TCD was used to monitor the peak systolic velocity(PSV)of bilateral middle cerebral artery(MCA)during the operation,and the blood pressure was regulated individually according to the changes of PSV,so as to decide whether to use CEA shunts to prevent the occurrence of cerebral hyperperfusion syndrome.Integrated carotid ultrasonography and TCD were used for reexamination and follow-up to evaluate the effect of CEA after the operation.Results Carotid artery stenosis and collateral circulation in all patients were evaluated through integrated carotid ultrasonography and TCD.Among them,there were 8 cases of subtotal occlusion of the internal carotid artery,15 cases of stenosis rate ranging from 50%to 69%with clinical symptoms,136 cases of stenosis rate ranging from 70%to 99%(including 4 cases of stent restenosis with stenosis rate ranging from 70%to 99%),and 6 cases of carotid web.Anterior communicating artery patency was present in 27 cases,posterior communicating artery patency in 38 cases,anterior-posterior communicating artery patency in 13 cases,and internal-external carotid artery collateral circulation was open in 42 cases,and no collateral artery opening in 9 cases,which was highly consistent with DSA or CTA results.Twenty-four cases underwent CEA with shunting.Among the patients who underwent CEA without a shunt,6 cases of mild cerebral hyperperfusion syndrome and 1 case of mild cerebral infarction occurred after operation.Within 7 days after operation,2 cases died,including 1 death from myocardial infarction and 1 death from sudden cardiac arrest.Internal carotid artery(ICA)occlusion occurred in one case who underwent ligation of ICA due to severe carotid artery stenosis with extracranial ICA aneurysm.ICA patency was found in all the other 163 patients in the first 6-month follow-up after operation.Conclusion The degree of carotid artery stenosis and the opening of collateral circulation assessed by integrated carotid ultrasonography and TCD were highly consistent with DSA.Integrated carotid ultrasonography and TCD can provide reliable information before,during and after CEA,improve the safety of surgery,and has important application value in the perioperative period of CEA.
作者
李俊青
李丹
柴建爽
王彦
宋志俊
李海芬
LI Jun-qing;LI Dan;CHAI Jian-shuang;WANG Yan;SONG Zhi-jun;LI Hai-fen(Department of Cardiovascular Ultrasound,the Third Hospital of Xingtai City,Hebei Province,Xingtai 054000,China;Anesthesia Department of Operating Room,the Third Hospital of Xingtai City,Hebei Province,Xingtai 054000,China;Department of Neurosurgery,the Third Hospital of Xingtai City,Hebei Province,Xingtai 054000,China)
出处
《河北医科大学学报》
CAS
2023年第7期844-850,共7页
Journal of Hebei Medical University
基金
邢台市重点研发计划(2021ZC102)。
