颈动脉转流管对预防颈动脉内膜剥脱术后脑过度灌注综合征的作用

Shunting during carotid endarterectomy prevents postoperative cerebral hyperperfusion syndrome

目的探讨颈动脉内膜剥脱术（CEA）术中应用颈动脉转流管对于防止术后脑过度灌注（CH）及脑过度灌注综合征（CHS）的保护作用。方法本研究为前瞻性非随机对照研究，经医院伦理委员会批准，自2009年8月至2012年8月，北京协和医院血管外科共人组具备CEA手术指征的颈动脉狭窄患者180例，其中男146例，女34例，年龄38—83岁，平均（66±9）岁。围手术期常规行经颅多普勒（TCD）脑血流监测。81例患者术中放置颈动脉转流管，99例未行转流。对比转流组及未转流组围手术期脑过度灌注（CH）、脑过度灌注综合征（CHS）及其他并发症的发生情况。结果转流组与未转流组在平均手术时间上差异无统计学意义[（144±25）min比（139±34）min，P〉0．05]，但前者较后者术中颈动脉阻断时间明显缩短[（4±4）min比（26±14）min，P〈0．05]。转流组围手术期CH（7．4％比18．2％，P〈0．05）及CHS（3．7％比12．1％，P〈0．05）发生率明显低于未转流组。而其他并发症发生率两者间差异无统计学意义（P〉0．05）。结论CEA术中应用颈动脉转流管，可明显缩短术中脑缺血时间，降低术后CH及CHS的发生率，但不增加手术时间及其他并发症发生率。因此，对于术前评估为CHS的高危患者，术中转流可能成为预防术后CHS的有效方法。

Objective To assess if shunting during carotid endarterectomy （CEA） can lower the risk of postoperative cerebral hyperperfusion （CH） and cerebral hyperperfusion syndrome （CHS）. Methods This study was a prospective non-randomized controlled trial which approved by human rights committee of our hospital. From August 2009 to August 2012, 180 eligible patients with carotid arterial stenosis who had indication for CEA entered our study. 146 patients were males and 34 patients were females. Their age range was 38 - 83 years. Average age was （ 66 ± 9） years. Cerebral blood flow changes were monitored through Transcranial Doppler routinely. There were 81 cases with shunting and 99 without shunting. We compared the rate of CH, CHS and other complications between two groups. Results No patient died or suffered hemorrhagic stroke. There were no significant difference in average operation time between two groups （ （ 144 ± 25 ） min vs （ 139 ±34 ） min, P 〉 0. 05 ）, but the clamping time of shunting group was significantly shorter than no shunting group （（4 ±4） min vs （26 ± 14） min, P 〈0. 05）. The rate of CH and CHS of shunting group is lower than no shunting group （7.4% vs 18.2%, P 〈 0.05; 3.7% vs 12. 1%, P 〈 0.05）. There were no differences in other complications between two groups. Conclusion Shunting during CEA can lower the rate of CH and CHS by shortening the time of intraoperative cerebral ischemia, but didn＇t increase the rate of other complications. Using shunt may be an effective method of preventing CHS after CEA, especially for the high risk patients according to preoperative evaluation.