颈动脉内膜剥脱手术患者10例的麻醉与监测体会

Experience on anesthesia and monitoring for 10 patients with carotid endarterectomy

目的探讨颈动脉内膜剥脱手术(CEA)患者麻醉与监测的安全性和可行性。方法回顾性分析我院2019年3月1日至2020年6月30日收治的10例因颈动脉粥样硬化性血管狭窄而在全麻下行CEA的患者。记录手术时间、出血量、颈动脉阻断时间、术中血压调控、大脑中动脉血流速度监测(MCAV)和颈动脉阻断前后分时段的颈静脉氧饱和度监测(SjvO_(2)),随访术后患者苏醒状况和相关并发症处理,总结麻醉与监测体会。结果10例患者平均手术时间(2.06±0.56)h,平均出血量(259.15±60.57)ml,平均颈动脉阻断时间(31.03±9.17)min。其中8例阻断过程中维持血压在基线水平上再提高10%-20%,术中监测SjvO_(2)60%-70%、MCAV80-100 cm/s;余2例行放置颈动脉转流管。手术结束9例患者30 min内恢复自主呼吸,意识清醒后拔除气管导管送监护病房,1例术后6 h意识未完全恢复,脑血管造影患侧低血流,转重症监护室治疗20天后痊愈出院,所有患者术后3个月随访未发生永久性并发症。结论CEA关键在于围术期根据脑血流监测控制循环,防止低灌注和再灌注损伤。

Objective To investigate the safety and feasibility of anesthesia and monitoring for patients with carotid endarterectomy(CEA).Methods The clinical data of 10 patients who underwent CEA under general anesthesia due to carotid atherosclerotic vascular stenosis and were admitted to our hospital from March 1,2019 to June 30,2020 were reviewed.The operation time,blood loss,duration of carotid occlusion,intraoperative blood pressure regulation,monitoring of middle cerebral artery flow velocity(MCAV),and periodic monitoring of jugular venous oxygen saturation(SjvO_(2))before and after carotid occlusion were recorded.The recovery status and handling of related complications were followed up,and the experience on anesthesia and monitoring was summarized.Results The average duration of operation,average blood loss and average duration of carotid occlusion were(2.06±0.56)h,(259.15±60.57)ml and(31.03±9.17)min respectively of the 10 patients.Out of the 10 patients,there were 8 patients whose blood pressure was increased by 10%-20%at the baseline level during the occlusion,and the SjvO_(2) and MCAV monitored during operation were 60%-70%and 80-100 cm/s,respectively.The carotid artery shunt was placed in the other 2 patients.There were 9 patients recovered spontaneous respiration within 30 min at the end of the operation,the tracheal tube was removed after consciousness,and those patients were sent to the monitoring ward.One patient had incomplete recovery of consciousness 6 hours after operation and low blood flow in the affected side of cerebral angiography,and was cured and discharged after transferring to the intensive care unit for 20-day treatment.There was no permanent complications occurred in all patients during 3 months of follow-up after the operation.Conclusion When implement the CEA,it is critical to control the circulation,avoid low perfusion and reperfusion injury according to the cerebral blood flow monitoring in the perioperative period.