中重度颈动脉狭窄行颈动脉内膜切除术中常规转流和选择性转流的临床应用对比

Comparison of routine shunting and selective shunting in patients with moderate and severe carotid artery stenosis undergoing carotid endarterectomy

目的 比较中重度颈动脉狭窄患者行颈动脉内膜切除术（CEA）术中常规转流与选择性转流的疗效.方法 选择行CEA的中重度颈动脉狭窄患者192例,按随机数字表法分为对照组（术中常规颈动脉转流）和观察组（术中根据经颅多普勒监测结果行选择性转流）,每组96例.记录患者术中颈动脉阻断时间以及术后30 d卒中事件的发生情况.结果 观察组经TCD监测行颈动脉转流率为35.4％（34/96）,其中合并对侧颈动脉闭塞或重度狭窄患者行颈动脉转流率为8/13,单侧颈动脉狭窄患者行颈动脉转流率为31.3％（26/83）,两者比较差异有统计学意义（χ2=13.006,P〈0.01）.两组颈动脉阻断时间比较差异无统计学意义（t=2.091,P〉0.05）;观察组行颈动脉转流患者术中颈动脉阻断时间明显短于未行颈动脉转流患者[（4.36±0.48）min比（10.15±0.91）min],差异有统计学意义（t=7.884,P〈0.05）.两组术后30 d卒中发生率比较差异无统计学意义（χ2=1.189,P〉0.05）.结论 颈动脉狭窄患者CEA术中采用选择性转流可使围手术期卒中事件发生率降低,尤其对合并对侧颈动脉重度狭窄或闭塞患者给予术中转流可取得很好的临床效果.

Objective To compare the therapeutic effect between routine shunting and selective shunting in patients with moderate and severe carotid artery stenosis undergoing carotid endarterectomy （CEA）. Methods One hundred and ninety-two patients with moderate and severe carotid artery stenosis undergoing CEA were selected, and the patients were divided into control group （routine shunting） and observation group （selective shunting） according to the random digits table method with 96 cases each. The intraoperative carotid artery occlusion time and incidences of stroke event 30 d after operation were recorded. Results In the observation group, the rate of carotid artery shunting was 35.4％ （34/96）, among which the rate of carotid artery shunting in patients with contralateral severe carotid artery stenosis or occlusion was 8/13, the rate of carotid artery shunting in patients with unilateral carotid stenosis was 31.3％ （26/83）, and there was statistical difference （χ2 = 13.006, P〈0.01）. There was no statistical difference in intraoperative carotid artery occlusion time between control group and observation group （ t=2.091, P〉0.05）. In the observation group, the intraoperative carotid artery occlusion time in patients with carotid artery shunting was significantly shorter than that in patients without carotid artery shunting：（4.36 ± 0.48） min vs. （10.15 ± 0.91） min, and there was statistical difference （t=7.884, P〈0.05）. There was no statistical difference in the incidence of stroke event 30 d after operation between control group and observation group （χ2 = 1.189, P〉0.05）. Conclusions The selective shunting during CEA can reduce the incidence of postoperative stroke event in patients with carotid artery stenosis, and especially it can give a good clinical effect in the patients with contralateral severe carotid artery stenosis or occlusion.