CAJ | 학술논문

目的探讨单侧颈动脉重度狭窄甚至闭塞的患者的围术期处理,寻找使患者安全平稳度过围术期的措施.方法选择我院自2008年1月至2009年3月收治自康复科和神经内科转入我科并伴有神经功能缺陷的患者,按指定标准选入34例行颈内动脉内膜剥脱术(CEA)手术.结合脑血流监测,探讨围术期对血压控制、转流管应用、抗凝及脱水治疗等方面的综合处理措施,注意全程脑保护.结果 34例患者中,除1例术中血压波动较大,估计远处栓子脱落,术后CT及MRI证实术侧多发梗死灶,1例患者未使颈内动脉再通,余患者术后恢复满意,NIHSS评分均有所下降.结论病情稳定患者,越早手术干预颈动脉重度狭窄甚至闭塞的患者,可能对患者带来越大的收益.围术期平稳控制血压是全程脑保护的中心问题,对颈动脉重度狭窄甚至闭塞的患者尤为重要.
목적 탐토단측경동맥중도협착심지폐새적환자적위술기처리,심조사환자안전평은도과위술기적조시.방법 선택아원자2008년1월지2009년3월수치자강복과화신경내과전입아과병반유신경공능결함적환자,안지정표준선입34례행경내동맥내막박탈술(CEA)수술.결합뇌혈류감측,탐토위술기대혈압공제、전류관응용、항응급탈수치료등방면적종합처리조시,주의전정뇌보호.결과 34례환자중,제1례술중혈압파동교대,고계원처전자탈락,술후CT급MRI증실술측다발경사조,1례환자미사경내동맥재통,여환자술후회복만의,NIHSS평분균유소하강.결론 병정은정환자,월조수술간예경동맥중도협착심지폐새적환자,가능대환자대래월대적수익.위술기평은공제혈압시전정뇌보호적중심문제,대경동맥중도협착심지폐새적환자우위중요.
Objective To explore the perioperative management of patients with unilateral carotid artery severe stenosis or occlusion in order to carry the patients through the perioperative period safely.Methods In our hospital from January 2008 to March 2009,patients were treated in Rehabilitation Division and department of Neurology and transferred to our department, accompanied by neurological dysfunction in patients selected according to specified standards into the thirty-four cases CEA surgery. Combination of cerebral blood flow monitoring, to explore perioperative blood pressure control and shunt applications, anticoagulation and dehydration treatment in a comprehensive treatment measures and pay attention to whole brain protection.Results Thirty-four patients, except one case of intraoperative blood pressure fluctuations, the estimated distance off emboli, postoperative CT and MRI confirmed the surgery side of multi-infarct foci, one patient did not make the internal carotid artery recanalization, the rest patients after satisfactory recovery, NIHSS scores have been reduced.Conclusions The patients in stable condition, the earlier the surgical intervention of severe carotid artery stenosis or occlusion in patients may bring greater benefits for patients. Perioperative control of blood pressure is stable throughout the central issue of cerebral protection, right carotid artery severe stenosis or occlusion in patients is particularly important.