经颅多普勒超声在颈动脉内膜剥脱术围手术期的临床应用价值

Application of transcranial Doppler ultrasound in the perioperative period of carotid endarterectomy

目的探讨经颅多普勒超声(TCD)在颈动脉内膜剥脱术(CEA)围手术期的临床应用价值。方法选取2015年3月—2019年12月于徐州医科大学附属淮安医院行CEA治疗的颈动脉狭窄患者32例,由TCD医生对所有患者进行术前评估、术中监测、术后评估。结果23例颈动脉重度狭窄患者中有前交通支和患侧后交通支开放者17例(73.9%),9例颈动脉中度狭窄患者中有前交通支和后交通支潜在开放者6例(66.7%)。患者临时阻断颈动脉前大脑中动脉(MCA)平均血流速度(Vm)较麻醉前下降(P<0.05),临时阻断颈动脉后MCA Vm较麻醉前及临时阻断颈动脉前下降(P<0.05),解除阻断颈动脉后MCA Vm较麻醉前及临时阻断颈动脉前升高(P<0.05);临时阻断颈动脉后有创血压较临时阻断颈动脉前上升(P<0.05),解除阻断颈动脉后有创血压较临时阻断颈动脉后下降,且低于临时阻断颈动脉前(P<0.05);10例患者MCA Vm低于基础值的70%;3例解除阻断颈动脉后MCA Vm较临时阻断颈动脉前增加超过100%。术后患侧的MCA平均峰值血流速度及搏动指数(PI)升高(P<0.05),交通动脉关闭。术后1例患者出现头痛,3例出现烦躁不安。结论TCD可准确评估颈动脉内膜剥脱术前颅内交通动脉开放情况,术中实时监测脑血流动力学改变,并指导适时调控血压,预防围手术期脑缺血及过度灌注的发生,术后可评估患者脑血流恢复及侧支循环关闭情况,有利于提高手术成功率。

Objective To evaluate the application of transcranial Doppler(TCD)in the perioperative period of carotid endarterectomy(CEA).Methods A total of 32 carotid artery stenosis patients underwent CEA from March 2015 to December 2019 in the Affiliated Huai′an Hospital of Xuzhou Medical University.All the patients were evaluated before during and after surgery by TCD.Results There were 17 patients with communicating branches among 23 severe carotid stenosis patients(73.9%).There were 6 patients with communicating branches among 9 moderate carotid stenosis patients(66.7%).The mean velocity(Vm)of middle cerebral artery(MCA)decreased before temporary obstruction compared with those before anesthesia(P<0.05).The MCA Vm decreased after temporary obstruction compared with those before anesthesia and before temporary obstruction(P<0.05).The MCA Vm increased after temporary obstruction was relieved increased compared with those before anesthesia and before temporary obstruction(P<0.05).The invasive blood pressure increased after temporary obstruction compared with those before temporary obstruction(P<0.05).The invasive blood pressure decreased after temporary obstruction was relieved compared with those after temporary obstruction and before temporary obstruction(P<0.05).There were 10 patients with MCA Vm lower than 70%of the basic value,and 3 patients with over 100%increases in MCA Vm after temporary obstruction was relieved compared with those before temporary obstruction.Patients presented increases in MCA Vmax and pulse index(PI)on the diseased side(P<0.05),and the communicating artery was closed.One patient reported headache and three patients presented restlessness.Conclusions TCD can accurately evaluate the openness of intracranial communicating artery before CEA.Real-time monitoring the changes of cerebral hemodynamics during operation,timely regulation of blood pressure,preventing cerebral ischemia and over perfusion in the perioperative period,and evaluating the recovery of cerebral blood flow and the closure of collateral circulation after operation,can promote the success rate of surgery.