[1]曲广泽,毛建辉.复合监测下颈内动脉内膜剥脱术治疗重度颈内动脉狭窄的临床研究[J].卒中与神经疾病杂志,2023,30(01):71-75.[doi:10.3969/j.issn.1007-0478.2023.01.013]
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复合监测下颈内动脉内膜剥脱术治疗重度颈内动脉狭窄的临床研究()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第30卷
期数:
2023年01期
页码:
71-75
栏目:
论著
出版日期:
2023-03-20

文章信息/Info

文章编号:
1007-0478(2023)01-0071-05
作者:
曲广泽; 毛建辉
053000 河北医科大学(曲广泽); 哈励逊国际和平医院[毛建辉(通信作者)]
关键词:
颈动脉内膜切除术 经颅多普勒超声 术中电生理监测 诱发电位
分类号:
R543.5
DOI:
10.3969/j.issn.1007-0478.2023.01.013
文献标志码:
A
摘要:
目的 探讨复合监测下颈内动脉内膜剥脱术治疗重度颈内动脉狭窄的应用价值。方法 对63例颈内动脉重度狭窄患者行颈动脉内膜剥脱术(Carotid endarterectomy,CEA)治疗,术中联合经颅多普勒(Transcranial dopple,TCD)和体感诱发电位(Somatosensory evoked potential,SEP)、运动诱发电位(Motor evoked potential,MEP)监测,用TCD监测并记录手术侧大脑中动脉(Middle cerebral artery,MCA)血流动力学的变化及栓子脱落情况,通过电生理监测记录术中SEP,MEP波幅的变化; 神经外科医生进行术后脑缺血事件评估:(1)术后第1、3、5 d美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评分较术前≥4分,认为发生神经功能缺损;(2)颅脑磁共振成像(Magnetic resonance imaging,MRI)或计算机断层扫描(Computed tomography,CT)显示同侧大脑新发梗死灶。结果 患者经术中TCD和SEP,MEP联合监测均顺利完成手术,可将术后患者是否发生神经功能缺损或有无新发梗死灶分为2组:(1)术后不良事件组,63例患者中有3例(4.7%);(2)术后无不良事件组,63例患者中有60例(95.3%)。其中,2组TCD在夹闭时和开放后无显著性差异(P>0.05),而在夹闭5 min后具有显著性差异(P=0.002); 2组在夹闭时、夹闭5 min后和解除夹闭时SEP,MEP均有显著性差异(P<0.05)。63例患者中有10例开放动脉夹后出现高灌注现象。结论 重度颈内动脉狭窄患者CEA手术期间同时进行TCD和电生理监测,电生理监测方法在预测术后不良事件方面要优于TCD,依据电生理指标调整术中及术后的脑血流灌注也许更为可靠,从而减少术后不良事件的发生。

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更新日期/Last Update: 2023-03-20