颈动脉转流管在颈动脉内膜切除术中的脑保护意义再评价

Re-evaluation of brain protection of carotid shunt tube in carotid endarterectomy(CEA) in extracranial carotid stenosis treatment

目的:探讨在颈动脉内膜剥脱术(Carotid endarterectomy,CEA)中应用颈动脉转流管对于大脑的保护作用。方法:回顾性分析颈动脉狭窄行颈动脉内膜剥脱术的59例患者的临床资料。其中,术中常规使用了转流管的患者入组35例(A组),术中未使用转流管患者中入组24例(B组)。分析随访资料中颈动脉内膜剥脱术后30 d内两组患者的新发脑卒中、TIA等并发症的发生情况及病死率,评估颈动脉内膜剥脱术中应用转流管对于预防术后并发症及对于脑的保护作用。结果:A组1例(2.86%)患者术后发生小面积脑梗死,3例(8.57%)患者术后出现过度灌注综合征,无死亡病例。B组1例(4.17%)患者术后发生小面积脑梗塞,1例(4.17%)患者术后发生大面积心肌梗死,抢救无效死亡;1例(4.17%)患者发生过度灌注综合征。比较A、B两组不良事件的发生情况无统计学意义(P>0.05)。结论:在颈动脉内膜剥脱术中,常规应用颈动脉转流管并不能降低围手术期不良事件发生的风险。

Objective： Re-evaluation of the protective effect of carotid shunt tube for the brain in Carotid endarterectomy（CEA）. Methods： This is a retrospective study of 59 patients with carotid stenosis undergone carotid endarterectomy. Thirty-five patients（A group） were used the conventional carotid shunt tube in CEA,while 24 patients（group B） were not given the carotid shunt tube. The new onset of stroke, TIA, other complications, and mortality in 30 days after CEA were compared between the two groups. The brain protection of the carotid shunt tube in Carotid endarterectomy（CEA） in extracranial carotid stenosis treatment was also evaluated. Results： In group A, 1 patient（2.86%） suffered small area of cerebral infarction, 3 patients（8.57%）suffered cerebral hyperperfusion syndrome. In group B, 1 patients（4.17%） suffered small area of cerebral infarction, 1 patient（4.17%） suffered myocardial infarction and died later, 1 patient（4.17%） showed cerebral hyperperfusion syndrome. There is of no statistical significance（P〉0.05） in terms of the occurrence rate of adverse events between groups. Conclusion： The conventional use of the carotid shunt tube in Carotid endarterectomy（CEA） on extracranial carotid stenosis treatment does not reduce the risk of perioperative complications.