经颅多普勒超声监测下颈动脉内膜切除术后脑血流过度灌注临床研究

Clinical study of cerebral hyperperfusion following carotid endarterectomy according to transcranial Doppler ultrasonography monitoring

目的探讨颈动脉内膜切除术后脑血流过度灌注临床特点和经颅多普勒超声（TCD）监测下治疗脑血流过度灌注之疗效。方法回顾分析2013年1—8月实施颈动脉内膜切除术且行TCD监测的60例（63例次）患者的临床资料，根据围手术期TCD监测结果判断患者是否存在脑血流过度灌注或脑过度灌注综合征。结果术后7d三维CTA检查显示，60例（63例次）患者颈动脉狭窄完全解除，术后30d内不良事件发生率分别为轻度缺血性卒中（1例次占1．59％）、心肌梗死（1例次占1．59％）、声音嘶哑（1例次占1．59％），无脑出血和死亡病例。术后脑血流过度灌注4例次（6．35％），持续1～3d，其中1例次（1．59％）为脑过度灌注综合征，表现为精神亢奋，幻觉和睡眠障碍。术后视力明显改善3例次占4．76％，其中1例次发生脑血流过度灌注。结论颈动脉内膜切除术围手术期TCD监测可以早期发现术中和术后脑血流过度灌注，及时根据TCD监测结果控制血压异常变化，是减少术后脑出血并发症之关键。

Objective To investigate clinical features of cerebral hyperperfusion following carotid endartereetomy （CEA）, and to explore the effect of treating cerebral hyperperfusion following CEA according to transeranial Doppler ultrasonography （TCD） monitoring. Methods Sixty-three CEAs were performed under general anesthesia from January to August 2013 and TCD monitoring was performed during the surgery. Carotid shunts were applied on the basis of TCD monitoring. Cerebral hyperperfusion and cerebral hyperperfusion syndrome （CHS） following CEA were determined and treated according to perioperative TCD monitoring. Results Postoperative three-dimensional CTA confirmed that carotid artery stenosis was released in all of those patients. During 30 d after CEA, one patient （1.59%） suffered mild isehemie stroke, one patient （1.59%） myocardial infarction, and one patient （1.59%） hoarseness. There was no eases of cerebral hemorrhage or death. Four patients （6.35%） suffered cerebral hyperperfusion following CEA, lasting for 1-3 d, and among them one patient （1.59%） suffered CHS, the clinical symptoms of which included excitement, hallucination and sleep disorder. In 3 eases （4.76%）, postoperative visual acuity improved significantly, and among them one patient suffered cerebral hyperperfusion. Conclusions TCD monitoring could detect intraoperative and postoperative cerebral hyperperfusion early. On the basis of TCD monitoring, blood pressure control is the key for reducing postoperative intraeranial hemorrhage.