经颅多普勒超声联合体感诱发电位监测在颈动脉内膜剥脱术中的应用价值

目的探讨经颅多普勒超声(TCD)联合体感诱发电位(SEP)监测在颈动脉内膜剥脱(CEA)术中的应用价值。方法对29例颈动脉狭窄患者在CEA术中采用TCD和SEP联合监测,用TCD监测术侧大脑中动脉(MCA)平均血流速度(Vm)的变化,并记录同时段SEP波幅的变化。根据术中TCD和SEP的变化综合判断是否实施转流术,并判断开放颈动脉后有无出现脑血流高灌注。结果本组患者经术中应用TCD和SEP联合监测均顺利完成手术;3例TCD监测MCA Vm及SEP波幅下降均达到转流标准的患者,术中行转流术。SEP(10.3%,3/29)和TCD(44.8%,13/29)监测达到转流标准比率的差异有统计学意义(χ2=4.118,P=0.002)。5例患者TCD监测示术中出现脑血流过度灌注,但此时SEP并无阳性表现,通过适当降血压及压迫颈动脉处理,其中仅1例患者术后出现脑过度灌注综合征。本组患者术后1周内复查CTA或DSA显示颈动脉狭窄均消失。术后随访3~18个月,仅1例患者在术后第10 d出现术侧手功能区小片状脑梗死,其他患者均无出现并发症。结论TCD与SEP联合监测在CEA术中具有较高的临床应用价值;SEP在判断术中是否使用转流方面更有优势,TCD在判断CEA术中高灌注方面有优势。

Value of transcranial doppler sonography combined with somatosensory evoked potential monitoring in carotid endarterectomy

Objective To investigate the application value of transcranial Doppler(TCD)combined with somatosensory evoked potential(SEP)monitoring in carotid endarterectomy(CEA).Methods TCD and SEP were used to monitor the mean blood flow velocity(Vm)of middle cerebral artery(MCA)during CEA in 29 patients with carotid stenosis.The amplitude of SEP was recorded at the same time.According to the changes of TCD and SEP during the operation,it can judge whether to implement the bypass operation and whether there was cerebral blood flow hyperperfusion after reestablish the carotid circulation.Results The operation was successfully completed with TCD and SEP monitoring during the operation.3 patients whose MCA VM and SEP amplitude decreased meet the criterion of bypass underwent bypass during the operation.There was significant difference between SEP(10.3%,3/29)and TCD(44.8%,13/29)in the standard rate of bypass(χ2=4.118,P=0.002).TCD monitoring showed cerebral hyperperfusion in 5 patients,but there was no positive expression of SEP at the time.Only 1 patient developed cerebral hyperperfusion syndrome after operation through proper autihypotension therapy and carotid artery compression.CTA or DSA showed that carotid artery stenosis disappeared within 1 week after operation.The patients were followed up for 3-18 months,only one patient developed small patchy cerebral infarction in the functional area of the operated hand on the 10th day after operation,and other patients had no complications.Conclusions The joint monitoring of TCD and SEP has high clinical application value in CEA.SEP has more advantages in judging whether to use bypass or not,TCD has advantages in judging high perfusion in CEA.