多参数监测在颈动脉内膜斑块剥脱术中的应用

Application of multi-parameter monitoring to carotid endarterectomy for patients with carotid artery stenosis

目的探讨多参数监测在颈动脉内膜斑块剥脱术(CEA)中的作用。方法回顾性分析2016年5月至2021年12月在多参数联合监测下实施CEA治疗的75例颈动脉狭窄的临床资料。术中应用颈内动脉返流压及体感诱发电位、运动诱发电位监测。结果72例返流压≥25 mmHg,3例<25 mmHg;58例体感诱发电位无明显变化,2例轻度降低复通后好转,6例下降超过50%但恢复,5例下降超过50%未恢复,4例下降超过75%未恢复。术中5例使用转流管。术后发生脑卒中2例,未发生栓塞事件。术后1周内复查颈动脉CTA显示颈总动脉及颈内动脉均通畅,1例颈外动脉闭塞,1例颈外动脉血栓形成并管腔重度狭窄。术后随访3个月~5年,末次随访GOS评分5分74例,3分1例。结论CEA是预防缺血性脑卒中的有效方法,术中联合监测颈动脉返流压、体感诱发电位和运动诱发电位,是可行的、有效的,可提高CEA的效果。

Objective To investigate the clinical efficacy of carotid endarterectomy(CEA)under multi-parameter monitoring for patients with carotid artery stenosis(CAS).Methods The clinical data of 75 patients with CAS who underwent CEA under multiparameters monitoring from May 2016 to December 2021 were retrospectively analyzed.During the operation,the stump pressure(StP)of the internal carotid artery(ICA),somatosensory evoked potentials(SSEP)and motor evoked potentials(MEP)were monitored simultaneously.Results CEA was completed in all the patients.The StP of 72 patients was more than 25 mmHg and 3 less than 25mmHg.SSEP did not significantly change in 58 patients,mildly decreased in 2 patients with improvement after recirculation,dropped by more than 50%with recovery in 6 patients,dropped by more than 50%without recovery in 5 patients,and dropped by more than 75%without recovery in 4 patients.Selective shunt was used in 5 patients during the operation.The postoperative ischemic events occurred in2 patients.No embolization occurred after the operation.CTA within 1 week after surgery showed that the common carotid artery and ICA were patency in all the patients,external carotid artery occlusion occurred in 1 patient,and severe stenosis of external carotid artery occurred in 1 patient.The follow-up(range,3 months to 5 years)showed a GOS score of 5 in 74 patients and a score of 3 in 1 at the last follow-up.Conclusions CEA is an effective method for the prevention of ischemic stroke.Intraoperative monitoring of StP,SSEP,and MEP is feasible and effective,which can improve the effectiveness of CEA.