颈动脉内膜切除术中经颅多普勒超声监测的应用

Clinical Applications of Transcranial Doppler Monitoring During Carotid Endarterectomy

目的应用经颅多普勒超声(trascranial Doppler,TCD)术中监测研究颈动脉内膜切除术(carotidendarterectomy,CEA)术中的脑血流变化和微栓子出现的规律。方法应用TCD监测18例颈内动脉严重狭窄或闭塞者CEA中各期的同侧大脑中动脉(middle cerebralartery,MCA)的脑血流和微栓子信号(microembolic signal,MES)。记录CEA各期MCA收缩期血流速度(peak systolic velocity,PSV)、搏动指数(pulsitility index,PI)及微栓子的数量。结果 (1)术中1例患者出现左眼动脉颞上支栓塞,其余患者无并发症。(2)释放期和缝合期MCA的PSV及PI较基线期明显升高(P<0.01)。44.4%(8/18)的患者阻断后PSV下降>60%。术中,77.8%(14/18)的患者采取了分流措施。释放颈内动脉后33.3%(6/18)的患者PSV升高100%以上。(3)100%的患者于手术中监测到MES。患者的总MES为11～150个,平均60±42个。栓子主要集中于分流期和释放期。结论 TCD作为一项无创、实时的监测工具能够广泛应用于CEA术中监测,及时地发现围手术期的各种血流变化及MES的产生,有效预测围手术期的卒中发生,优化术中操作。

Objective The purposes of our study are to detective middle verebral artery （MCA） blood flow velocity changes and microembolism during carotid endarterectomy（CEA） by transcranial Doppler（TCD） monitoring and to examine the suitability of intraoperative TCD monitoring. Methods Eighteen patients with internal carotid artery stenosis （〉70%） or occlusive underwent CEA under TCD monitoring of peak systolic blood flow velocity, pulsatility index and microembolic signals in the ipsilateral middle cerebral artery. Results （1） Only one patient has got left ophthalmic artery embolism after CEA. （2） MCA velocity and plusatility index increase significantly during period of cross release and wound closure（P〈0.01）. 44.4% of patients with MCA velocity decrease over 60% at cross-clamping. 77.8% of patients receive shunting. 33.3% of patients with MCA velocity increase over 100% at cross release. （3） Microembolic signal （MES） in 100% of patients was detected during CEA. The amount of MES are between 11 to 150, which the mean MES are 60-42. More MES were detected at shunting and cross release. Conclusion lntraoperative TCD monitoring provides online surveillance of both hemodynamic changes and cerebral microembolism in the middle cerebral artery on aspects of surgery, which can predict perioperative stroke effectively and optimize operation.