术前颈动脉测压预测颈内动脉切除的可行性研究

The feasibility study of prediction internal carotid artery whether can resection by monitoring carotid artery pressure preoperative

目的:通过术前暂时性颈内动脉球囊阻断试验及监测颈动脉残端压的变化规律,进一步预测患侧颈动脉结扎切除的可能性,评估手术风险以及为手术方式的选择提供参考依据。方法:连续性监测并记录阻断前和阻断过程中的颈动脉残端回流压,密切观察阻断过程中患者的精神状态及神经系统方面各种表现体征,了解患者残端动脉回流压的动态变化情况以及能否顺利通过颈动脉球囊阻断试验。结果:19例患者,4例阳性,15例阴性。阻断即刻阳性患者与阴性患者残端压降幅均值分别为(57.35±1.89)%和(38.99±12.23)%,两者差异有统计学意义。阻断过程中阳性患者与阴性患者残端压均值分别为(37.29±3.15)mmHg和(61.36±14.69)mmHg,两者具有统计学意义。结论:约有21.05%的患者不能耐受颈动脉球囊阻断试验,理论上需行颈内动脉重建手术。阻断后残端回流压力小于40.44 mmHg,理论上需行颈内动脉重建手术。阻断即刻动脉残端压降幅超过55.46%,理论上需行颈内动脉重建手术。

Objective：Through preoperative temporary balloon occlusion of internal carotid artery and monitoring of carotid artery stump pressure variation,in order to further predict the risk of carotid artery ligation and resection,evaluation operative risk and provides the reference for the choice of surgical approach.Method：Continuous monitoring and recording the carotid artery stump return pressure,before clamping and in the process of blocking,close observation the patients mental state and the nervous systemof all kinds of signs,in the process of blocking,to understand the dynamic change of stump artery pressure return in patients and whether can the smooth passage of carotid artery balloon occlusion test.Result：Of the 19 patients,4cases were positive,15 negative cases,Blocking immediate the positive patients and negative patients with stump pressure drop was（57.35±1.89）% and（38.99 ± 12.23）%,with statistical significance between the two,in the process of blocking,the mean stump pressure of the positive patients and the negative patients was（37.29±3.15）mmHg and（61.36±14.69）mmHg,with statistical significance between the two.Conclusion：Approximately 21.05% of patients can not tolerate carotid artery balloon occlusion test,theory for carotid artery reconstruction operation.After blocking the stump pressure is less than 40.44 mmHg,the theory for reconstruction of the internal carotid artery operation.Blocking instant artery stump pressure dropped more than 55.46%,in theory the need for internal carotid artery reconstruction.