颈动脉重建术治疗颈动脉瘤的护理配合

[目的]探讨颈动脉重建技术在颈动脉瘤手术治疗中的护理配合.[方法]对19例因颈动脉瘤行颈动脉重建术病人做好充分术前准备,术中配合默契、熟练,密切关注手术进程.[结果]手术过程顺利,病人术后安返病房,无严重并发症发生,达到满意的手术及护理效果.[结论]术前充分有效的准备,术中准确、科学的护理配合可使手术顺利进行,也是手术成功的重要保证.     

颈动脉重建术治疗颈动脉瘤的护理配合

[目的]探讨颈动脉重建技术在颈动脉瘤手术治疗中的护理配合.[方法]对19例因颈动脉瘤行颈动脉重建术病人做好充分术前准备,术中配合默契、熟练,密切关注手术进程.[结果]手术过程顺利,病人术后安返病房,无严重并发症发生,达到满意的手术及护理效果.[结论]术前充分有效的准备,术中准确、科学的护理配合可使手术顺利进行,也是手术成功的重要保证.     

超声影像在颈动脉夹层诊断中的特征分析

目的本研究目的分析颈动脉夹层的超声表现,总结颈动脉夹层超声特征。方法选择2007年1月~2014年12月北京天坛医院经MRA(n=10)和/或DSA(n=10)证实的颈动脉夹层患者共计20例,男17例,女3例,年龄25~68岁(中位年龄46岁),结合MRA或DSA分析颈动脉夹层在超声影像中的图像特征。结果 20例颈动脉夹层患者其中颈总动脉夹层5例,颈内动脉夹层15例。超声能够明确诊断颈动脉夹层患者12例,表现为典型"双腔管"征(真腔和假腔),检出率60%;超声诊断颈动脉夹层总符合率75%,漏诊率25%。Youden指数为75%。结论超声诊断颈动脉夹层与DSA/MRA相比具有较高符合率,可以作为评价颈动脉夹层的首选无创性筛查手段,最终诊断依赖于DSA/MRA。     

左侧颈总动脉先天性发育不良致闭塞合并颈内动脉狭窄、颈外动脉完全性反流超声表现1例

患者女,34岁.主因"长期言语不利、头晕,加重伴肢体活动障碍3天"就诊.超声检查采用Acuson Sequoia 512超声仪,15L8W宽频线阵探头(频率为8.0 MHz),CV Artery条件,检查时使探查条件、频率、取样框及取样容积的倾斜方向、角度的校正为44°,翻转等条件始终保持不变,采集双侧颈总动脉(common carotid artery, CCA)、颈内动脉(internal carotid artery, ICA)、颈外动脉(external carotid artery, ECA),发现:①左侧CCA、ICA血流频谱异常(提示左侧CCA起始段、ICA远端狭窄或闭塞的可能);②左侧ECA血流反向(ECA窃血表现);③右侧CCA、ICA流速较左侧增高(以ICA为著),左侧椎动脉(vertebral artery, VA)流速较右侧高(考虑代偿性表现);④双侧VA血流频谱示左侧VA峰值流速较右侧增高,双上肢动脉频谱未见异常.本院MRI示左侧CCA起始段血管管腔较细、ICA颅内段血管较右侧细.外院DSA示左侧CCA起始段管腔变细并闭塞,ICA颅内段管腔较对侧变细.手术证实为左侧CCA起始段先天性发育不良致闭塞.     

Bilateral carotid artery dissection after dental work

Carotid artery dissection has been reported to occur spontaneously and after many types of neck trauma. A case patient is presented who developed a right-sided oculosympathetic palsy and was found to have bilateral carotid artery dissection after she visited her dentist. To the best of our knowledge, this case represents the first report of bilateral carotid dissection following dental work.     

糖尿病患者颈动脉、眼动脉及视网膜中央动脉的改变

目的应用高频超声检测糖尿病患者颈动脉、眼动脉及视网膜中央动脉病变,为临床提供有参考价值的数据.方法检测32例糖尿病患者(合并或者无高血压)和14例正常对照组颈动脉内中膜复合体厚度(IMT),弹性指数(Ep),僵硬指数(β),眼动脉(OA)、视网膜中央动脉(CRA)的收缩期峰值血流速度(Vs)、舒张末期流速(Vd)、血管阻力指数(RI).结果与对照组比较,糖尿病无高血压及合并高血压患者颈动脉IMT增厚,Ep、β增高(P<0.01),眼动脉、视网膜中央动脉的Vd下降(P<0.01),RI增高(P<0.01).结论糖尿病患者颈动脉内中膜复合体增厚,弹性度降低,视网膜血液供应不良.高频超声在糖尿病血管病变的诊断中具有重要的实用价值.     

探讨内皮型一氧化氮合酶对颈动脉支架置入术后血管内膜的影响

目的通过分析颈动脉支架术患者血清中内皮型一氧化氮合酶(eNOS)的表达及血管内皮功能的改变,进一步探讨支架术后再狭窄的机制。方法将符合入组标准的患者根据是否有手术指征分为颈动脉支架组、颈动脉粥样硬化组。在入组前及术后1 h、1个月、6个月抽血采用ELISA测定血清eNOS,并测定血管内皮功能及颈动脉内膜中层厚度(IMT)。结果动脉粥样硬化组组内不同时间点血清eNos、IMT、血管舒张反应(FMD)比较差异无统计学意义(F=16.156,13.009,11.785,P>0.05);颈动脉支架组在支架置入后血清eNOS表达水平明显下降,FMD下降、颈动脉内膜厚度增厚,两组比较差异有统计学意义(F=104.521,176.501,167.116,P<0.05);阿托伐他汀治疗后血清eNOS表达水平上调,FMD上升、颈动脉内膜厚度下降并与剂量相关,差异有统计学意义(F=123.328,207.442,206.721,P<0.05);颈动脉支架组与动脉粥样硬化组比较差异有统计学意义(F=134.812,P<0.05)。结论 eNOS可以抑制颈动脉支架术后血管内膜的增生,减少再狭窄发生。     

Blunt carotid artery injury

Blunt carotid artery injury is an uncommon injury with a potentially devastating outcome. Although treatment is often unhelpful for an established neurologic deficit, there is frequently a delay between the episode of trauma and the onset of neurology. This delay provides a window of opportunity where early detection and intervention may significantly improve outcome and prevent lifelong morbidity in a generally young trauma patient population. This paper will review the literature regarding incidence, outcome, treatment options and optimal methods of diagnosis for this lesion. The following synopsis of a case seen at Royal Perth Hospital Emergency Department illustrates several of the classical features of blunt carotid injury, including delayed presentation and pattern of associated injuries. The patient, a 19‐year‐old female, presented following a single vehicle motor crash. On arrival she had a Glasgow Coma Scale (GCS) of 14 with no focal neurologic deficit. Multiple injuries were identified, including a large scalp laceration, a compound fracture of the mandible, pneumothorax, sternal fracture, subcapsular haematoma of the liver, and a knee laceration. Initial computed tomography (CT) scan of the head was normal. Twenty hours after the motor vehicle accident the patient's conscious state deteriorated to GCS 9. Repeat CT head demonstrated changes consistent with a left middle cerebral artery infarct. Cerebral angiography revealed traumatic dissection of the left internal carotid artery with complete occlusion of the lumen just distal to its origin. After 13 days in the intensive care unit and 2.5 months in the rehabilitation unit, she was discharged with a persistent severe receptive and expressive aphasia, as well as a dense right hemiparesis. She is now living at home with community supports.     

预测颈动脉粥样硬化超声指标的相关性研究

目的探讨超声判断颈动脉粥样硬化程度的四项常用指标间的相关性。方法超声测量200例正常成人不同年龄组颈动脉内-中膜厚度、内中膜背向散射积分(IBS)、肱动脉内皮依赖性舒张功能及颈动脉物理参数(僵硬度、扩张性、顺应性),分析各项指标间的相关性。结果颈动脉内中膜IBS与内-中膜厚度、颈动脉僵硬度呈正相关性,颈动脉内中膜IBS与肱动脉内皮舒张功能、颈动脉扩张性及顺应性呈负相关。结论临床联合应用该四项指标能够为早期发现动脉粥样硬化提供客观的判定标准。     

大脑中动脉狭窄对颅外段颈内动脉血流动力学的影响

目的研究不同程度的大脑中动脉(MCA)狭窄对颅外段颈内动脉(ICA)血流动力学的影响。方法本研究纳入单侧MCA狭窄或闭塞的患者98例,根据狭窄程度分为对照组(MCA中度狭窄,N=46)与观察组(MCA重度狭窄或闭塞,N=52),使用彩色多普勒超声测量两侧颅外段ICA的收缩期峰值流速(Vp)、舒张末期流速(Vd)、平均流速(Vm)、搏动指数(PI)。结果与对照组相比,观察组患侧ICA的Vp、Vm及Vd较健侧明显降低(41.17cm/s vs48.76cm/s,21.22cm/s vs 28.23cm/s,11.82cm/s vs 17.92cm/s,P均<0.05),而患侧PI值明显高于健侧(1.43vs1.20,P<0.01),PI值差值显著增大(0.28vs 0.06,P<0.05)。结论颅外段颈内动脉血流动力学的改变在一定程度上提示了大脑中动脉狭窄的严重程度,能够有效提高TCD对于大脑中动脉狭窄或闭塞进行诊断的准确性。     

超声引导下行颈动脉窦阻滞在颈动脉支架成形术中的应用价值

目的 该研究通过对照性研究旨在探讨超声引导颈动脉窦阻滞在颈动脉支架成形术（Carotid Artery Stenting, CAS）中的应用价值。方法 采用前瞻性随机对照研究方法,选择2017年1月-2019年6月我院拟行CAS的颈内动脉狭窄患者共145例,使用随机数字表法将患者随机分为两组：A组（73例）术前在超声引导下常规行患侧颈动脉窦阻滞,B组（72例）术前不做处理。观察A组患者颈动脉窦阻滞过程中有无不良反应,并记录阻滞时间、麻醉药物用量。监测并比较两组患者术中发生心动过缓、低血压、心脏骤停及术后发生脑卒中事件例数。结果 两组患者一般资料具有可比性（P＞0.05）。A组术中低血压、心动过缓人数比例分别为4/73、12/73,均小于B组的16/72、35/72,差异均具有统计学意义（P＜0.05）。A组围手术期无心脏停搏和脑卒中事件发生,B组术中发生1例心脏停搏,术后出现3例脑卒中事件。A患者围手术期心脏停搏和脑卒中事件总发生率低于B组（5.56%）,差异有统计学意义（P＜0.05）。A组患者在颈动脉窦阻滞过程中出现1例患侧上眼睑下垂,经休息后好转。两组患者均顺利完成手术。结论 术前在超声引导下行患侧颈动脉窦阻滞可减少术中低血流动力学改变事件的发生,该技术操作简便,总体安全可行,值得临床进一步推广应用。     

基于微信平台的延续护理在颈动脉狭窄患者行颈动脉支架植入术后的应用效果

目的探讨基于微信平台的延续护理在颈动脉狭窄患者行颈动脉支架植入术后的应用效果。方法选择2019年1月—2020年12月于浙江省台州医院行颈动脉支架植入术的120例颈动脉狭窄患者为研究对象,根据随机数字表法将其分为干预组和对照组,各60例。对照组患者应用常规出院指导及随访护理,干预组在对照组的基础上实施基于微信平台的延续护理。采用简易生活质量量表(SF-36)、家庭亲密度与适应性量表中文版(FACESⅡ-CV)、自制治疗依从性调查问卷调查两组患者的生活质量、家庭功能、治疗依从性。结果干预后,干预组患者SF-36评分及FACESⅡ-CV评分、治疗依从性均高于对照组,差异均有统计学意义(P<0.05)。结论基于微信平台的延续护理可以有效提升行颈动脉支架植入术后颈动脉狭窄患者的生活质量、治疗依从性及家庭功能,值得临床应用。     

颈动脉支架成形术对颈动脉重度狭窄患者生活质量及认知功能的影响

目的观察颈内动脉支架成形术（CAS）对颈动脉重度狭窄患者生活质量及认知功能的影响。方法选取近两年在本院接受治疗的64例重度颈动脉狭窄患者,均行CAS治疗,术前及术后3、12个月对患者进行简易精神状态量表（MMSE）、日常生活能力量表（ADL）、词语流畅性测验（RVR）、数字广度（DS）、视觉保持测验（VRT）和生活质量量表（WHOQDL）评分。结果手术成功率高达100％,且术后无栓塞、颈内动脉血栓等并发症发生。患者术后颈动脉狭窄率降低,且颈动脉血流显著改善。治疗后3、12个月,患者的MMSE、VR及DS评分均明显升高,而ADL评分显著降低,其中治疗后12个月的升高及降低程度明显大于治疗后3个月。治疗后3个月,患者Ⅵ汀正确评分及WHOQOL评分显著增加,而Ⅵ汀错误评分明显降低。结论CAS能明显改善颈动脉重度狭窄患者的认知功能及生活质量,值得临床推广应用。     

医源性颈动脉损伤的病例分析与讨论

医源性颈动脉损伤可由多种有创诊断和治疗方式引起,如颈部放射治疗、经前路颈椎手术、中心静脉置管术、脑血管造影术、鼓膜切开术、颅底手术等,由于颈动脉是负责脑部供血的主要血管,其损伤可能会产生一系列严重的不良后果。及时正确地处理医源性颈动脉损伤有助于改善患者的预后,降低损伤带来的不良影响。     

血流动力学平衡的颈内动脉及椎-基底动脉的介入治疗

目的 探讨出现血流动力学平衡现象的颈内动脉及椎-基底动脉狭窄患者的介入治疗方案.方法 患者52例,其中行颈内动脉支架成形术介入治疗27例,未处理6例,行颈内动脉栓塞术1例;行椎动脉及基底动脉支架成形术介入治疗16例,行椎动脉栓塞术2例.结果 一次性成功植入支架43例,栓塞病变血管3例,未行介入处理6例;颈动脉支架术后闭塞3例.结论 对于病变血管发生血液动力学平衡的患者应行个体化治疗.     

Headache in carotid artery stenting and angiography

Introduction.— Carotid angioplasty headache and diagnostic criteria are based on scarce data and small series. Here, we aimed to determine presence, frequency, and characteristics of headache after carotid artery stenting and angiography headache and speculate on possible mechanisms of head and neck pain emerging during or after the carotid artery stenting procedure. Patients and method.— The total of 64 patients who were admitted to our Neuroradiology Division of Radiology Department for primary percutaneous transluminal carotid interna stenting were included in the study. They had symptomatic or asymptomatic carotid artery disease with stenosis more than 70%. All patients were questioned by a neurologist regarding the presence, side, location, quality, severity, duration, and timing of headache after both angiography and stenting procedures. Results.— Frequency of headache after carotid interna stenting was 39.1%, it commonly arose in a short period after the procedure and relieved in 10 minutes. This type of headache was mild, ipsilateral, frontotemporal in location, pressing in nature, and arose frequently within 10 minutes after the procedure, whereas angiography headache had a frequency of 21.9% and it was ipsilateral, mild, burning‐like headache. Angiography headache also relieved within 10 minutes. Both types of headache were related to severe stenosis. Discussion.— Our study clearly demonstrates that headache is seen after carotid artery stenting (39.1%) and angiography (21.9%). Although both types of headache have similar characteristics, they differ in that it is mostly pressing in the group of carotid artery stenting and burning in angiography group.     

原发性高血压患者颈动脉病变的临床分析

目的：探讨原发性高血压患者颈动脉病变和血压水平、年龄及血脂之间的关系。方法：采用超声检测60例原发性高血压患者和10例健康者的颈动脉内膜中层厚度及斑块大小，同时进行血脂、高血压分级及年龄比较。结果：（1）高血压病患者颈总动脉及颈内动脉内膜中层厚度与高血压分级呈正相关，血压分组越高者，颈动脉内膜增厚越明显；（2）随着年龄的增加，患者颈动脉斑块阳性率增加，不同年龄组之间差异显著；（3）颈动脉内膜增厚组和斑块组与胆固醇、低密度脂蛋白有一定的相关性。结论：高血压患者颈动脉内膜的病变程度受血压水平、年龄及血脂等因素的影响。     

Management of patients with concomitant coronary and carotid artery disease

Introduction: Ideal management of concomitant carotid and coronary artery occlusive disease remains under investigation. Although researchers have advocated the potential benefits of varying treatment strategies based on either concomitant or staged surgical treatment, there is no consensus in treatment guidelines. With emerging data suggesting favorable outcome of carotid artery stenting (CAS) compared to carotid endarterectomy (CEA) in patients with critical coronary artery disease, physicians must consider these diverging therapeutic options.

Areas covered: This review presents current evidence regarding the prevalence of carotid stenosis in patients with coronary artery disease, the common pathophysiologic links with an emphasis on the diverse mechanisms of stroke in the coronary artery bypass grafting (CABG) setting and discusses the contemporary registries and observational studies comparing outcomes of various revascularization strategies in high-risk patients. Authors conducted a literature search in two bibliographic databases including papers published from 1983 until 2018 (PubMed, Scopus).

Expert opinion: Symptoms should drive the need to intervene on carotid stenosis in patients undergoing coronary revascularization. Carotid artery stenting has gained significant ground, especially among those individuals considered of high surgical risk. PCI may be considered as an alternative option for the management of severe concurrent coronary disease.     

冠心病患者颅外颈动脉狭窄的发生率及危险因素

目的 观察可疑冠心病者颅外颈动脉狭窄（ECCAS）的发生率,评价致ECCAS的危险因素.方法 对106例患者行冠状动脉造影（CAG）后作颈动脉数字减影血管造影（DSA）;据CAG结果分正常及冠心病组,后者分为1、2、3支病变组;据DSA结果分为无ECCAS及有ECCAS组,后者分为轻、中、重度狭窄;危险因素与ECCAS的关系用单变量及多变量Logistic回归分析.结果 冠心病组ECCAS发生率（36.5%）明显高于对照组（6.3%）（P〈0.01）;冠状动脉病变程度与ECCAS程度显著正相关（rs=0.431,P〈0.01）;老龄（OR=1.183,P〈0.01）、高血压（OR=5.456,P〈0.01）、冠状动脉病变程度（OR=1.799,P〈0.05）是ECCAS的独立危险因素.结论 同时行CAG和颈动脉DSA显示,ECCAS多见于有高血压的老年严重冠心病患者.