颈动脉内膜剥脱的回顾性分析（附9例报告）

目的 探讨颈动脉内膜剥脱术的手术指征、手术方法及围手术期的处理方法。回顾性分析9例颈动脉狭窄患者的临床资料。方法 2004年10月～2006年10月经颈部彩超初选，全脑DSA明确，9例患者颈动脉狭窄50～80％（均为单侧），全麻下行颈动脉内膜剥脱术。结果 8例患者的短暂性脑缺血表现消失。部分患者慢性脑缺血症状也得到明显的改善。1例患者术后1d死于严重心功能不全。结论 严重颈动脉狭窄患者行预防性颈动脉内膜剥脱术，对预防和治疗缺血性脑卒中的发生具有满意的疗效。作好围手术期处理，有助于减少手术并发症发生。     

颈动脉内膜剥脱治疗颈动脉狭窄的临床研究

目的：颈动脉内膜剥脱术治疗颈动脉硬化性狭窄引起的缺血性脑卒中的临床应用,探讨其防治措施。方法回顾性分析青海大学附属医院心胸血管外科自2009年至今收治的因严重颈动脉硬化性狭窄行颈动脉内膜剥脱术的20例患者临床的临床资料。结果本组中20例患者均采用气管插管静脉复合麻醉,20例患者的均采用外翻式颈动脉内膜剥脱术(CEA)。术后轻度神经损伤1例,占5%；1例于术后3d出现偏瘫,占5%；全组无围术期死亡病例。临床随访16例,随访率为80%,平均随访(12±4)月。术后患者脑缺血症状消失或明显改善14例,占70%；症状改善、好转者3例,占15%；术后颈动脉再狭窄发生1例(均<50%),占5%。结论颈动脉内膜剥脱术疗效肯定,远期症状性再狭窄未见发生,适合狭窄程度超过50%有症状的患者及狭窄程度在70%~99%的近6个月有短暂脑缺血发作或缺血发作的颈动脉狭窄患者。     

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

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。     

颈动脉内膜剥脱术在防治缺血性脑卒中的临床分析

目的对颈动脉内膜剥脱术预防和治疗缺血性脑卒中的临床疗效进行评价。方法对30例经检查确诊为脑卒中患者,行颈动脉内膜剥脱术,剥离颈动脉斑块。结果30例患者术后恢复良好,脑缺血症状有明显改善,围手术期内未出现死亡及脑卒中事件。随访6-24个月未出现脑卒中,未出现严重并发症,且病人的生活质量有明显改善。结论颈动脉内膜剥脱术对预防和治疗缺血性脑卒中是安全有效的。     

人工颈椎间盘置换术的手术配合

目的:探讨人工颈椎间盘置换术的手术配合要点。方法:对6例患者进行术前准备、术中配合及术后护理,仔细记录手术配合的全过程。结果:6例手术顺利完成,术后恢复快,无手术并发症发生。结论:周密的术前准备,术中熟练的护理配合,是手术成功的关键之一。     

颈腹联合切口下咽、颈段食道癌切除术的护理

目的总结下咽、颈段食道癌颈腹联合切口手术的护理体会.方法对11例患者行癌肿切除,食道剥脱、胃代食道咽胃肠吻合术,加强心理护理,做好术前术后的护理及康复指导.结果 11例患者均可戴气管套管出院,仅一例出现咽瘘.结论对手术前后配合有效的护理措施,可提高疗效,促进患者早日恢复,提高病人的自理能力和生活质量.     

颈腹联合切口下咽、颈段食道癌切除术的护理

目的总结下咽、颈段食道癌颈腹联合切口手术的护理体会.方法对11例患者行癌肿切除,食道剥脱、胃代食道咽胃肠吻合术,加强心理护理,做好术前术后的护理及康复指导.结果11例患者均可戴气管套管出院,仅一例出现咽瘘.结论对手术前后配合有效的护理措施,可提高疗效,促进患者早日恢复,提高病人的自理能力和生活质量.     

颈腹切口下咽、颈段食道癌切除术的护理

目的 总结下咽、颈段食道癌颈腹联合切口手术的护理体会。方法 对11例患者行癌肿切除，食道剥脱、胃代食道咽胃肠吻合术，加强心理护理，做好术前术后的护理及健康指导。结果 11例患者均可戴气管套管出院，仅一例出现咽瘘。结论 对手术前后配合有效的护理措施，可提高疗效，促进患者早日恢复，提高病人的自理能力和生活质量。     

颈动脉内膜剥脱术后早期认知功能的康复训练

目的探讨早期认知功能康复训练对颈动脉内膜剥脱术后患者认知功能的影响。方法回顾性分析2016年1月至2018年6月重庆市急救医疗中心神经外科收治的32例颈动脉狭窄行颈动脉内膜剥脱术(CEA)患者的临床资料。将2016年1月至2017年6月CEA术后行常规处理的16例患者作为对照组,2017年7月至2018年6月收治的16例患者CEA术后在常规处理的基础上行早期认知功能康复训练作为认知训练组,分析2组患者术后1周、3个月蒙特利尔认知评估量表(MoCA)评分值。结果 2组患者术后1周MoCA评分与术前比较,差异无统计学意义(P 0. 05),术后3个月MoCA评分均较术前显著升高(P 0. 05),认知训练组较对照组变化更显著(P 0. 05)。结论颈动脉内膜剥脱术后,早期实施认知功能康复训练有助于降低术后认知功能障碍发生率,改善患者的认知功能。     

颈动脉分叉区域的神经血管解剖及其对颈动脉内膜剥脱术的临床意义

目的　通过对尸体标本的颈动脉分叉区域内的神经、血管进行解剖研究,为安全有效地开展颈动脉内膜剥脱术提供形态学依据及解剖学基础。 方法 选取20例（40侧）无明确心、脑血管疾患的尸体解剖标本（男11例、女9例）,采取颈动脉内膜剥脱术式入路对颈动脉分叉区域内的神经、血管进行解剖研究,明确血管和神经的形态学及结构特点。 结果 颈总动脉分叉部形态可分为Ⅰ、Ⅱ、Ⅲ型,分别占比为10%、52.5%、37.5%。分叉位置以甲状软骨为界,左侧颈总动脉分叉部高度在其上缘以上、平上缘和上缘以下的占比分别为55%、37.5%、7.5%;相较之下右侧分别为62.5%、27.5%、10%。男性颈总、颈内、颈外动脉内径均大于女性（P<0.05）;男性颈动脉分叉角度大于女性（P<0.05 ）。双侧颈总、颈内、颈外动脉内径相比无统计学意义（P>0.0 5）;左侧颈动脉分叉角度大于右侧（P<0.05）。 结论　通过对颈动脉分叉区域内的神经、血管进行解剖研究,对颈动脉内膜剥脱术术中血管与神经的保护具有重要的临床意义。     

Distribution of carotid body type I cells and other periadventitial type I cells in the carotid bifurcation regions of the cat

Summary The bilateral distribution of carotid body type I cells was investigated in five non-pedigree cats by serially sectioning the carotid bifurcation regions. Carotid body type I cells occurred bilaterally in close proximity to the wall of the occipital artery or one of its proximal branches, and less frequently the ascending pharyngeal artery within a division of connective tissue with defineable but irregular borders. Caudally, and separate from the principal mass of carotid body type I cells, isolated groups of periadventitial type I cells were found in seven out of ten specimens lying freely in the connective tissues around the occipito-ascending pharyngeal trunk and the origin of the occipital artery immediately rostral to the carotid bifurcation. Periadventitial type I cells were not observed at the level of the carotid bifurcation but on one occasion these cells were noted caudal to the carotid bifurcation lying adjacent to the wall of the rostral end of the common carotid artery. From our data on four specimens, reconstructions were made of the carotid body. The occurrence and significance of the periadventitial type I cells is discussed.     

Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study

OBJECTIVES:

A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting.

MATERIALS AND METHOD:

Twenty‐nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end‐diastolic velocity, cm/s) were measured 24 hours after the procedures and also at 12 months post‐procedure. Residual stenoses (immediately post‐procedure) and restenoses (within 12 months of procedure) were defined as narrowings of ≥50% on duplex ultrasound examination.

RESULTS:

In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24‐hour and 12‐month post‐procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis) were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34%) and the patch closure group (1 case, 1.53%, P  =  0.08). At 12 months, 2 stenting patients (6.88%) and 2 patch closure patients (3.07%) had ≥50% restenosis (P  =  0.58). One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention.

CONCLUSION:

Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or patched carotids.     

颈总动脉末段、颈动脉窦处动脉粥样硬化和血栓的研究现状

目的：探讨颈动脉末段、颈动脉窦处的粥样硬化和血栓的研究现状。方法：系统回顾近年来对颈动脉粥样硬化病变的研究,在诱因及病因、危害、诊治几个方面作分析讨论。结果：颈动脉粥样硬化的发生、发展受血流动力学、血管病变、血液成份三个因素影响;病因与自身生活饮食习惯、多种疾病密切相关;颈动脉粥样硬化、血栓可引起脑缺血、脑卒中等严重损害;诊断一般采用影像学技术,治疗方法有药物及手术两种。结论：颈动脉粥样硬化及血栓可引起脑缺血、脑中卒等脑血管疾病,应尽可能采取早期预防、早期诊断,以避免脑血管疾病的发生。     

Three types of neurochemically defined autonomic fibres innervate the carotid baroreceptor and chemoreceptor regions in the guinea-pig

Summary The innervation of the carotid body, carotid sinus, and neighbouring arteries (common carotid artery; external carotid artery; occipital artery; ascending pharyngeal artery) was investigated in guinea-pigs by means of glyoxylic acid-induced catecholamine-fluorescence and immunohistochemistry using a variety of antisera against neuropeptides and tyrosine hydroxylase (TH). Fibres displaying catecholamine-fluorescence, TH- and neuropeptide Y-like immunoreactivity (NPY-LI) were less numerous in the carotid sinus than in all other arterial segments. Vasoactive intestinal polypeptide (VIP)-LI axons were almost lacking in the common carotid, external carotid and occipital arteries, consistently found in the carotid sinus, and more numerous in the ascending pharyngeal artery. Catecholaminergic, TH-, NPY- and VIP-LI fibres were observed deep in the media of the carotid sinus, where the baroreceptor terminals are located. In contrast, they did not enter the media in the adjacent arterial segments. All these fibres disappeared following excision of the superior cervical ganglion, but were unaffected by combined transection of the carotid sinus nerve and resection of the nodose ganglion, suggesting a sympathetic origin. Doublestaining immunofluorescence revealed at least three types of autonomic, presumably sympathetic fibres in the carotid sinus: 1) TH⁺/NPY⁺, 2) NPY⁺/VIP⁺, and 3) VIP⁺ fibres. This points to a non-noradrenergic efferent innervation of the carotid sinus in addition to the hitherto known noradrenergic sympathetic fibres. The three populations of autonomic fibres seen in the carotid sinus were also observed in the carotid body, but the paucity of NPY⁺/VIP⁺ double-labelled fibres raises doubt as to the functional significance of this particular fibre type in modulating arterial chemoreception. The multiplicity of neurochemically defined autonomic nerves to the carotid baro- and chemoreceptor regions probably reflects functionally separate pathways that are differently regulated and exert different effects.     

The volume of the carotid body and periadventitial type I and type II cells in the carotid bifurcation region of the fetal cat and kitten

Summary The bilateral distribution of carotid body type I cells was investigated in 6 fetuses (gestational age 95%) and 9 newborn kittens (aged 1 day to 4 days) by serially sectioning the carotid bifurcation regions. In most specimens type I cells occurred in close proximity to the wall of the occipital artery or one of its small proximal branches within a division of connective tissue with defineable but irregular borders. This combination of type I cells and connective tissue constituted the principal mass of the carotid body. Using an interacting image analysis system, the area of the carotid body in each serial section was measured by accurately contouring its perimeter. The volume of the carotid body was calculated by multiplying the sum of the areas of the serial sections by the thickness of the section. The volume of the carotid body was 0.052±0.018 mm³ in the fetuses and 0.025–0.117 mm³ in the 1–4 day old kittens. A degree of symmetry in the values for the volume of the right and left carotid body was found. Caudally, and separate from the principal mass of carotid body type I cells, isolated groups of periadventitial type I cells were noted in the connective tissues around the occipito-ascending pharyngeal trunk, origin of the occipital artery and rostral end of the common carotid artery in 7 out of 12 specimens from fetal cats and 11 out of 18 specimens in newborn kittens. The volumes of the periadventitial groups of cells ranged between 25–1,365 m³ in fetuses and 10–1,351 m³ in kittens.     

Gender Differences in the Association between Depressive Symptoms and Carotid Atherosclerosis among Middle-Aged and Older Koreans: The Namwon Study

We investigated the association of depressive symptoms with carotid intima-media thickness (IMT) and plaques in the general Korean population. A total of 7,554 Korean males and females aged 45-74 yr who were free from cardiovascular diseases were included in the analyses. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Subjects with a score of ≥16 were classified as having clinically significant depressive symptoms. Carotid ultrasonography was used to measure mean carotid IMT (C-IMT) and to determine the presence of plaques. A significant association between depressive symptoms and C-IMT was observed only in females. After adjustment for established cardiovascular risk factors, females with depressive symptoms had significantly greater C-IMT than females without depressive symptoms (mean difference 0.011±0.004 mm; 95% confidence interval, 0.003-0.019 mm). Compared with controls, the fully adjusted risk of females with depressive symptoms for abnormal C-IMT (≥1.0 mm) was significant (odds ratio, 1.63; 95% confidence interval, 1.16-2.30). No significant association between depressive symptoms and carotid plaques was observed in either gender. This study shows a significant association between depressive symptoms and C-IMT in middle-aged and older females.

Graphical Abstract

相似文献   

The effects of blood osmolality changes on cat carotid body chemoreceptors in vivo

The possibility that carotid chemoreceptors respond to changes in plasma osmolality was investigated in the cat, perfusing the carotid artery with blood made hyper- or hypo-osmotic and recording chemoreceptor activity from carotid nerve fibers. Blood made hyperosmotic with sucrose or NaCl reduced the chemoreceptor discharge, while hypoosmotic blood increased chemoreceptor activity. The minimal osmolality variation necessary to obtain a detectable frequency change was 3–8% of the control. Frequency changes of 30% of the control were obtained with a 20% variation in osmolality. The frequency variations produced by the osmotic changes lasted as long as the infusion was maintained (up to 15 min). In some instances a rebound was observed when iso-osmotic saline was perfused again. A transient change in frequency and a clear rebound were obtained when blood made hyperosmotic with glycerol was perfused. These effects probably reflect a rapid change in intracellular osmolality due to the free passage of glycerol across cellular membranes.The modifications in chemoreceptor activity consecutive to osmolality variations are the opposite of those observed in isolated and superfused carotid bodies. As it is known that osmolality values affect the smooth muscle of the blood vessels, we conclude that our results are mainly produced by changes in carotid body blood flow due to a direct effect of hyper- and hypo-osmotic solutions on vascular muscle tone. Chemoreceptor excitation during a decrease in blood osmolality may contribute reflexly to the increased vascular resistance observed during acute osmolality reductions in man.     

The effect of common carotid artery occlusion on blood pressure in the barodenervated cat

A 12% blood pressure elevation was found during common carotid occlusion in the barodenervated, thoracotomised cat under Nembutal anaesthesia. This rise in blood pressure appeared to be the net result of an 18% increase of total peripheral resistance and a concomitant 5% decrease of mean aortic flow.When the occlusions were repeated after ganglionic blockade similar values were found, indicating that the increase in resistance had not resulted from reflex vasoconstriction. To test if this increase of total peripheral resistance was caused by a mechanical exclusion, Ohm's law for parallel resistances was applied to the systemic tree to calculate the rise in resistance due to obstruction of the carotid flow. The results thus obtained matched the observed increase of peripheral resistance.It is concluded that common carotid artery occlusion can be used to test completeness of barodenervation in the cat, if an increase in blood pressure of about 12% is allowed for.     

血管回声跟踪技术对不同年龄正常人群颈动脉弹性功能的定量检测

探讨超声ET技术对颈动脉弹性功能的检测及不同年龄组颈动脉弹性值。应用ET技术检测145人颈动脉的β、Eρ、AC、AI及PWVβ，年龄22～84岁，平均47．0岁，男75例，女70例。年龄分5组：20～29岁，30～39岁，40~49岁，50~59岁，≥60岁。比较各年龄组左右两侧、男女之间及各组间动脉弹性的差异。左右两侧及性别之间颈动脉弹性指标无差异；随着年龄的增高，β、Eρ、AI、PWVβ增高，AC降低。正常人群不同年龄组的左右两侧及男女之间颈动脉弹性无差异；随着年龄的增高，颈动脉的弹性降低；ET技术可以敏感检测颈动脉的弹性功能状态。