颈动脉内膜切除术全程脑保护的应用

目的探讨全程脑保护在颈动脉内膜切除术(CEA)中的应用意义。方法2002年1月~2005年8月在全程脑保护概念指导下对30例患者行CEA手术。术前29例患者均行颈部彩色超声和CT血管造影检查,仅1例行颈动脉造影检查。全身麻醉、选择性颈动脉转流、彩色经颅多普勒(TCD)脑血流监测、精心而规范的操作是CEA术中脑保护的重要手段。术后脑保护方法是保留气管插管、脑冰帽,维持血压平稳,在TCD指导下应用脱水药物。结果30例患者中有10例行颈动脉转流,转流率为33%。17例(57%)做补片成型。全部患者术后恢复良好,无任何神经系统并发症,无手术死亡。结论全程脑保护概念应用于CEA手术能有效减少神经系统并发症的发生。

Application of cerebral protection to carotid endarterectomy at perioperation, intraoperation, and postoperation

Objective To evaluate the significance of cerebral protection applied at carotid endarterectomy (CEA) at perioperation, intraoperation, and postoperation. Methods Thirty patients underwent CEA with application of cerebral protection at perioperation, inoperation, and postoperation in our hospital from January 2002 to August 2005. Perioperative carotid doppler ultrasound and computed tomography angiography (CTA) were applied in 29 patients and carotid angiography applied in only one patient. The key methods of intraoperative cerebral protection included general anaesthesia, selective shunting, monitoring of transcranial doppler, and careful manipulation. The methods of postoperative cerebral protection included leaving tracheal cannula and brain ice-bag, maintaining normal blood pressure, and applying dehydrant under guidance by monitoring of transcranial doppler. Results Among all the 30 patients, shunts were used in 10 patients (33%), and angioplasty by patch was applied in 17 patients (57%). No cranial nerve-associaed complications or death was documented. Conclusion Application of cerebral protection at CEA at perioperation, intraoperation, and postoperation can effectively prevent the occurance of cranial nerve-associated complications.