颈动脉内膜剥脱术后脑过度灌注综合征围手术期干预分析

Perioperative Intervention Analysis of Cerebral Hyperperfusion Syndrome after Carotid Endarterectomy

目的探讨颈动脉内膜剥脱术后脑过度灌注综合征围手术期干预。方法回顾性分析2017年1月～11月我院57例患者因颈动脉狭窄行颈动脉内膜剥脱术后完整病例资料,围手术期监测头颈部CTA或DSA、经TCD、头部MRI,并动态监测患者收缩压,实现围手术期脑过度灌注综合征监测和有效干预。结果 57例患者经术后CTA/DSA证实颈动脉狭窄斑块完整切除,1例(1.75%)患者经临床症状及TCD、MRI影像学证实存在脑过度灌注综合征,出现头痛,手术对侧肢体肌力下降及认知功能下降,经积极控制血压及TCD动态监测,患者于术后7 d恢复正常。所有患者术后7 d无颈部血肿、声音嘶哑、颅内出血、脑缺血发作、植物生存及死亡患者。结论围手术期加强监测是防治颈动脉内膜剥脱术后脑过度灌注综合征的重要方法,而控制血压是治疗脑过度灌注综合征的有效干预手段。

Objective To investigate the perioperative intervention of brain hyperperfusion syndrome after carotid endarterectomy.Methods A retrospective analysis of 57 patients with carotid stenosis after carotid endarterectomy in our hospital from January toNovember 2017 was performed.Perioperative monitoring of head and neck CTA or DSA,TCD,and head MRI were performed during theperioperative period.The patient＇s systolic blood pressure was dynamically monitored to achieve perioperative monitoring of brainhyperperfusion syndrome and effective intervention.Results 57 patients underwent CTA/DSA to confirm the complete resection ofcarotid stenosis plaque.1 patient（1.75%）was confirmed by clinical symptoms,TCD and MRI to have cerebral hyperperfusion syndrome,headache,decreased muscle strength and cognitive function of the contralateral limbs.After active control of blood pressure and TCDmonitoring,the patient recovered to normal 7 d after operation.All patients had no cervical hematoma,hoarseness,intracranialhemorrhage,cerebral ischemic attack,vegetative survival or death 7 d after operation.Conclusion Perioperative monitoring is animportant method to prevent brain hyperperfusion syndrome after carotid endarterectomy.Control of blood pressure is an effectiveintervention for the treatment of brain hyperperfusion syndrome.