25例颈动脉内膜剥脱术临床分析及术中经颅多普勒超声监测体会

A clinical analysis of 25 cases of carotid endarterectomy and experience in intraoperative transcranial Doppler ultrasound monitoring

摘要:

目的 探讨颈动脉内膜剥脱术（CEA）对颈动脉狭窄患者的疗效及术中经颅多普勒超声（TCD）监测经验总结。方法 回顾25例CEA手术患者的临床资料及术中TCD监测情况。结果 患者平均年龄64±10岁，男性23例，女2例。其中，左侧颈动脉狭窄11例（44%），右侧13例（52%），双侧狭窄而右侧较重者1例（4%）。除3例术中发生探头移位而未记录完整（均使用转流）外，余22例均全程监测。可根据CEA术中TCD监测大脑中动脉（MCA）血流速度变化了解术侧颈动脉远端供血情况，以确定是否转流。同时全程监测微栓子情况；术后有1例（4%）患者出现轻度神经系统缺损症状；2例（8%）出现谵妄；余22例（88%）未出现新发神经精神症状。结论 CEA可有效解除颈动脉狭窄及颈动脉易损斑块、降低卒中风险，术中TCD监测可为手术安全提供一定保障。

Abstract:

Objective To investigate the therapeutic efficacy of carotid endarterectomy (CEA) in patients with carotid stenosis, and to summarize the experience in intraoperative transcranial Doppler (TCD) ultrasound monitoring.Methods A review was performed on the clinical data and intraoperative TCD monitoring data of 25 patients who underwent CEA.Results The mean age of the patients (23 males and 2 females) was 64±10 years. Among them, 11 patients (44%) had left carotid stenosis, 13 patients (52%) had right carotid stenosis, and 1 patient (4%) had bilateral carotid stenosis with more serious stenosis on the right side. All patients (except 3 patients who were not completely monitored due to probe dislocation during the surgery; by-pass technique was used for the three patients) were monitored through the process. The blood supply at the distal end of the carotid artery on the operative side could be identified based on the blood flow velocity of the middle cerebral artery monitored by TCD ultrasound during CEA, which could indicate whether by-pass operation was successful. Meanwhile, microemboli were monitored through the process. After the surgery, 1 patient (4%) had mild neurological deficits, 2 patients (8%) had delirium, and the remaining 22 patients (88%) had no newly emerging psychiatric or neurological symptoms.Conclusions CEA can effectively relieve carotid stenosis and resolve carotid vulnerable plaques and reduce the risk of stroke. TCD monitoring can provide assurance of surgical safety during CEA.