超声监测在颈动脉内膜切除术围手术期的应用

目的探讨彩色多普勒超声（CDFI）与经颅多普勒超声（TCD）的联合应用,在颈动脉内膜切除术（CEA）中的临床价值。方法 CEA前采用CDFI和TCD评价186例患者颈动脉的狭窄程度及颅内侧支循环开放情况,将其结果与DSA对照。术中应用TCD对双侧大脑中动脉（MCA）在CEA不同阶段的血流动力学变化进行动态监测,指导转流管的使用。术后即刻行TCD和CDFI检查,评估手术前后术侧颈动脉的内径变化及颅内外血流动力学参数的变化。结果①186例患者CDFI检出狭窄程度与DSA完全一致的为178例,与DSA对照,CDFI判断颈动脉中、重度狭窄的符合率为95.7%。②术中CDFI和TCD监测的186例患者中,167例侧支循环建立良好,无需放置转流管,其余19例颈动脉压迫试验显示代偿不完全。③术后即刻复查CDFI、TCD,186例患者经CEA后狭窄均得到解除,管径明显增宽,狭窄处残余内径由（1.5±0.4）mm增至（5.9±0.7）mm,差异有统计学意义,P〈0.01;颈动脉狭窄处收缩期峰值流速（PSV）及患侧MCA的舒张期末血流速度（PSV）、血管搏动指数（PI）恢复正常。颈动脉狭窄处血流速度由术前（547±51）cm/s降至（89±28）cm/s（P〈0.01）;患侧MCA的PSV由术前（58±14）cm/s升至（80±5）cm/s（P〈0.01）;患侧MCA的PI由术前的0.56±0.11升至0.92±0.13（P〈0.01）,脑部血液供应得到明显改善。结论CDFI和TCD在CEA术前筛查、术中监测及术后评估中,提供了可靠的客观依据,在CEA围手术期有很重要的临床应用价值。

Application of ultrasound monitoring during perioperative period of carotid endarterectomy

Objective To investigate the clinical value of color Doppler flow imaging(CDFI) in combination with transcranial Doppler ultrasonography(TCD) during carotid endarterectomy(CEA).Methods A total of 186 patients with carotid artery stenosis,the collateral circulation opening were evaluated using CDFI and TCD before CEA.The results were compared with digital subtraction angiography(DSA).The hemodynamic changes of CEA in bilateral middle cerebral artery(MCA) at different stages were monitored dynamically using TCD during the procedure for guiding the use of shunting.TCD and CDFI examinations were performed immediately after procedures.The changes of inner diameter and intracranial hemodynamic parameters on the operated sides before and after carotid surgery were evaluated.Results ① Of the 186 patients,the stenotic degree of 178 patients detected by CDFI were in consistence with the findings of digital subtraction angiography(DSA).Compared to DSA,the coincidence rate of the moderate to severe carotid artery stenosis was 95.7%.② Of the 186 patients monitored by intraoperative CDFI and TCD,167 had established good collateral circulation,shunting was not needed.The carotid compression test showed that the compensation of the other 19 was incomplete.③ CDFI and TCD reexamination immediately after procedure showed that the stenosis of 186 patients were disappeared after CEA.The inner diameters were obviously enlarged.The inner diameter at stenosis site increased from 1.5±0.4 mm to 5.9±0.7 mm(P<0.01);the peak systolic velocity(PSV),the end diastolic velocity(EDV) of the ipsilateral MCA at the site of carotid artery stenosis,and the pulsatility index(PI) were returned to normal.The blood flow velocity at the site of carotid stenosis decreased from 547 ± 51 cm/s before procedure to 89 ± 28 cm/s(P<0.01);the PSV of MCA increased from 58 ± 14 cm/s before procedure to 80 ± 5 cm/s(P <0.01);and the PI increased from 0.56 ± 0.11 before procedure to 0.92 ± 0.13(P<0.01).The blood supply of the brain was improved significantly.Conclusion CDFI and TCD may provide the reliable and objective bases in the CEA preoperative screening,intraoperative monitoring,and postoperative evaluation of carotid endarterectomy,so has very important clinical application value in the perioperative period of carotid endarterectomy.