经颅多普勒超声对颈动脉内膜切除术中选择性分流的评价

Evaluation of selective shunt with transcranial Doppler during carotid endarterectomy

目的采用经颅多普勒（transcranial Doppler，TCD）评价选择性分流在颈动脉内膜切除术（carotid endarterectomy，CEA）中的实施效果。方法采用TCD对169例接受CEA治疗的颈动脉狭窄患者行术中双侧大脑中动脉（middle cerebral artery，MCA）脑血流连续监测。根据是否实施分流术，将患者分类为分流组（n=32）和未分流组（n=137）。记录术前侧支循环开放途径，比较麻醉后、颈动脉夹闭前后、分流前后以及颈动脉开放后双侧MCA的收缩期峰值血流速度（peak systolic velocity，PSV）、平均血流速度（mean velocity,MV）、血管搏动指数（pulsatility index,PI）和MV变化率。结果颈动脉夹闭前分流组与未分流组MV分别为（34．73±13．54）cm／s和（35．32±13．18）cm／s，无显著差异（P=0．825）。颈动脉夹闭后分流组MV较未分流组显著降低（P=0．000），MCAMV下降率平均为69．34％±20．93％，较未分流组显著降低（P=0．000）。分流后MCAMV显著提高，平均提高（35．68±16．69）cm／s（P=0．000）。结论IUD可客观评价分流前后的脑血流动力学改变。

Objeclive Using transcranial Doppler （TCD） to evaluate the effect of selective shunt （SS） during carotid endarterectomy （CEA）. Methods TCD was used for intraop-erative bilateral middle cerebral artery （MCA） cerebral blood flow continuous monitoring in 169 patients with carotid stenosis treated with CEA. The patients were divided into shunt （n = 32） and non-shunt （n = 137） groups according to whether they performed shunt or not. The open approaches of anterior collateral circulation were recorded. The peak systolic velocity （PSV）, mean velocity （MV）, pulsatility index （PI）, and ratio of MV in bilateral MCA were compared after anesthesia, before and after carotid artery occlusion, before and after shunt, and after carotid artery open. Results MV before carotid artery occlusion in the shunt and non-shunt groups were 34.73±13.54 cm/s and 35.32±13.18 cm/s, respectively, and there was no significant difference （P = 0. 825）. MV in the shunt group after carotid artery occlusion was significantly decreased in the non-shunt group （P =0. 000）. The mean decline rate of MCA MV was 69.34% - 20.93%, and it was decreased more significantly than that in the non-shunt group （P = 0. 000）. The decline rate of MCA MV was increased significantly after shuntoperation, the average increase was 35.68±16.69 cm/s （P = 0. 000）. Conclusions TCD can objectively evaluate the hemodynamic changes before and after shunt operation.