全程脑保护概念在颈动脉内膜切除术中的应用

Whole course cerebral protection for patients undergoing carotid endarterectomy

目的 探讨全程脑保护在颈动脉内膜切除术(CEA)中的应用价值。方法 2002年1月至2004年8月在全程脑保护概念指导下对20例患者行CEA手术。术前所有患者中仅1例行颈动脉造影,其余均行颈部彩超和CTA检查。给予全身麻醉、选择性颈动脉转流、血管彩色Duplex( TCD)脑血流监测,术后脑保护方法是保留气管插管,脑冰袋、维持血压平稳,在TCD指导下应用脱水药物。结果 20例患者中,7例行颈动脉转流,转流率为35%。15例(85%)用补片做成形术。全部病例手术后恢复良好,无任何神经系统合并症发生,无手术死亡。结论 全程脑保护概念应用于CEA手术,能有效减少神经系统合并症的发生。

Objective To evalute perioperative whole course cerebral protection for patients undergoing carotid endarterectomy (CEA) Methods From 2002 to 2004, 20 patients received CEA in our hospital using whole course perioperative cerebral protection Preoperatively carotid angiography was performed in only one patient, while Doppler ultrasonography and CTA were applied to all patients Measures of intraoperative cerebral protection included general anaesthesia, selective shunting, and transcranial Doppler monitoring (TCD), followed by postoperative delayed removal of tracheal cannula, brain ice bag, maintaining blood pressure and appropriate use of diuretics under the guidance of TCD Results Shunt was used in 7 cases (35%), 15 patients (85%) underwent patch angioplasty There were no postoperative cranial nerves related complications Mortality was 0% Conclusion Perioperative whole course cerebral protection could effectively decrease postoperative cranial nerves related complications in patients undergoing carotid endarterectomy