多参数监测在颈动脉内膜剥脱术治疗合并对侧颈动脉中重度狭窄中的应用
Application of multi-parameter monitoring in carotid endarterectomy for moderate and severe contralateral carotid artery stenosis
闫宏旭 1安乾 1王梦宇 1胡昕涛 1殷向阳 1王兵1
作者信息
- 1. 郑州大学第五附属医院 血管外科,河南郑州 450052
- 折叠
摘要
目的 探索残端压(stump pressure,SP)、术中体感诱发电位(somatosensory evoked potential,SEP)、脑电图(electroencephalogram,EEG)和经颅多普勒超声(transcranial Doppler,TCD)监测在颈动脉内膜剥脱术(carotid endarterectomy,CEA)治疗合并对侧颈动脉中重度狭窄患者的应用和意义.方法 回顾性分析 2021 年 5 月至 2023 年 6 月郑州大学第五附属医院 26 例行CEA治疗合并对侧颈动脉中重度狭窄患者的临床资料,患者术中均行SEP、EEG、SP和TCD监测并设定预警标准,记录围手术期并发症发生情况及改良Rankin量表(modified Rankin scale,mRS)评分.结果 26 例患者发生多参数监测预警 34 次,其中SEP预警 7 次、EEG预警 8 次、SP预警 10 次、TCD预警 9 次.3 例患者在升压后未解除预警而使用转流管.术后发生症状性脑梗死 1 例,过度灌注综合征 2 例,颅神经损伤 1例.术后 3 个月复查影像学显示术侧颈动脉均通畅,均无新发脑血管事件和死亡.患者术后mRS评分0 分 21 例,1 分 4 例,2 分 1 例.结论 对于合并对侧颈动脉中重度狭窄的患者,CEA术中多参数监测可更准确地评估术中脑血流状态,指导转流管的合理使用,减少围手术期并发症的发生.
Abstract
Objective To explore the application and significance of stump pressure(SP),somatosensory evoked potential(SEP),electroencephalogram(EEG)and transcranial Doppler(TCD)monitoring during carotid endarterectomy(CEA)in patients with moderate to severe stenosis of the contralateral carotid artery.Methods The clinical data of 26 patients with moderate to severe stenosis of the contralateral carotid artery who underwent CEA at the Fifth Affiliated Hospital of Zhengzhou University from May 2021 to June 2023 were analyzed retrospectively.All patients underwent SEP,EEG,SP and TCD monitoring during the operation.Early warning standards were set,and perioperative complications and modified Rankin scale(mRS)scores were recorded.Results There were 34 multi-parameter monitoring warnings in 26 patients,including 7 SEP warnings,8 EEG warnings,10 SP warnings and 9 TCD warnings.Three patients did not clear the warning after increasing pressure and used shunts.One case of symptomatic cerebral infarction,2 cases of hyperperfusion syndrome and 1 case of cranial nerve injury occurred postoperatively.The follow-up imaging 3 months after the operation showed that that the carotid artery on the surgical side was unobstructed,and there were no new cerebrovascular events or deaths.The postoperative mRS score of the patients was 0 point in 21 cases,1 point in 4 cases,and 2 points in 1 case.Conclusion For patients with moderate to severe stenosis of the contralateral carotid artery,multi-parameter monitoring during CEA can accurately evaluate the intraoperative cerebral blood flow status,guide the rational use of shunt tubes and reduce the occurrence of perioperative complications.
关键词
颈动脉狭窄/颈动脉内膜剥脱术/残端压/体感诱发电位/脑电图/经颅多普勒超声/转流Key words
Carotid artery stenosis/Carotid endarterectomy/Stump pressure/Somatosensory evoked potential/Electroencephalogram/Transcranial Doppler/Shunting引用本文复制引用
出版年
2024
NETL
NSTL
维普
万方数据