颈动脉狭窄患者CEA应用颈动脉转流效果观察

目的:探讨颈动脉狭窄患者行颈动脉内膜剥脱术(CEA)术中使用颈动脉转流有效性及安全性。方法:回顾性分析79例颈动脉狭窄患者,术中通过经颅多普勒监测双侧大脑中动脉血流速度(VMCA)。阻断颈动脉前后记录系统收缩压、术侧VMCA、对侧VMCA。将79例患者分为两组:A组V2-a<40%V1-a 41例,使用颈动脉转流;B组V2-a≥40%V1-a 38例,未使用颈动脉转流。提高血压使术侧VMCA达到50%V1-a,即刻和恢复血供后记录系统收缩压、术侧VMCA、对侧VMCA。结果:A组、B组不良事件发生率分别为22.0%、5.3%(P=0.032);A组、B组主要不良事件发生率分别为9.8%、5.3%(P=0.743)。结论:颈动脉狭窄患者行CEA术,术中使用颈动脉转流增加不良事件发生率,但对主要不良事件发生率无明显影响,不常规推荐使用颈动脉转流管。

Application of shunting in CEA for patients with carotid stenosis

Objective:To assess the efficacy and safety if shunting during carotid endarterectomy(CEA)in patients with carotid stenosis.Methods:The retrospective study examined 79 patients with carotid stenosis from January 2015 to January 2019.The blood flow velocity of the bilateral middle cerebral artery(VBMCA)was monitored by intraoperative transcranial doppler(TCD).The systolic pressure,VMCA in the surgery side and the contralateral VMCA were recorded before carotid artery blocked.The systolic pressure,VMCA in the surgery side and the contralateral VMCA were recorded after carotid artery blocked,79 patients were divided into two groups:Group A(41 cases)V2-a<40%V1-a,with shunting;Group B(38 cases)V2-a≥40%V1-a,without shunting.The systolic pressure,VMCA in the surgery side and the contralateral VMCA were recorded when the VMCA reached 50%V1-a by raising blood pressure;The systolic pressure,VMCA in the surgery side and the contralateral VMCA were recorded after blood supply was restored.Results:The retrospective study suggested that the probabilities of cerebral vascular events in group A and B was 22.0%and 5.3%respectively with significant difference(P=0.032);The probabilities of ischemic stroke in group A and B was 9.8%and 5.3%respectively without significant difference(P=0.743).Conclusion:Shunting during CEA can increase the rate of cerebral vascular events in patients with carotid stenosis,but the incidence of ischemic stroke was not significant difference,and the shunting was not routinely recommended.