颈动脉狭窄患者围手术期脑部并发症的诊治

目的 探讨颈动脉狭窄患者围手术期脑部并发症的原因及其防治措施.方法 回顾性分析2004年5月至2009年6月间接受外科治疗的133例颈动脉狭窄患者围手术期脑部并发症的原因及其处理方式.结果 本组133例颈动脉狭窄患者,其中男97例,女36例;年龄62～78岁,平均(67±8)岁.其中94例接受颈动脉内膜剥脱术(carotid endarterectomy,CEA),39例接受颈动脉支架植入术(carotid artery stenting,CAS);围手术期16例出现脑部并发症,其中3例发病次数在2次以上;术前5例出现短暂性脑缺血发作(transient ischemic attacks,TIA)及一过性脑供血不足等并发症;CEA术中5例、CAS术中4例出现TIA发作和脑过度灌注综合征(cerebral hyperperfusion syndrome,CHPS)等并发症;术后8例患者出现TIA发作、脑过度灌注综合征、脑梗死及脑出血等并发症.结论 有效控制围手术期脑部并发症的发生是外科治疗颈动脉狭窄成败的关健,脑部并发症的防治应贯穿整个围手术期.

Prevention and treatment of cerebral complications in patients with carotid stenosis in perioperative period

Objective To investigate the causes of and prevention for cerebral complications in perioperative period in patients with carotid stenosis. Methods The causes and treatment of cerebral complications among 133 cases of carotid stenosis during perioperative period from May 2004 to Jun 2009 were analysed retrospectively. Results Among 133 cases, 94 cases underwent carotid endarterectomy (CEA) and 39 cases had carotid artery stenting(CAS). Cerebral complications developed in 16 cases including 3 cases of more than two attacks. 5 cases suffered from tansient ischemia attacks (TIA)or cerebral ischemia before operation. 5 developed TIA or cerebral hyperperfusion syndrome (CHPS) among those undergoing CEA and 4 developed TIA or CHPS among CAS cases. During postoperative period, 8 cases developed TIA, CHPS,cerebral infarction or cerebral hemorrhage. Conclusions Prevention and treatment of cerebral complications is extremely important durning surgical therapy of carotid stenosis.