中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2009年
8期
577-579
,共3页
徐东%刘飞%华扬%张科峰%刘燕晖%尚学斌%李洪利%姚青%李学锋%张蕊%李雅琼
徐東%劉飛%華颺%張科峰%劉燕暉%尚學斌%李洪利%姚青%李學鋒%張蕊%李雅瓊
서동%류비%화양%장과봉%류연휘%상학빈%리홍리%요청%리학봉%장예%리아경
颈动脉狭窄%冠状动脉分流术%心肺转流术%超声检查%多普勒%经颅
頸動脈狹窄%冠狀動脈分流術%心肺轉流術%超聲檢查%多普勒%經顱
경동맥협착%관상동맥분류술%심폐전류술%초성검사%다보륵%경로
Carotid stenosis%Coronury artery bypass%Cardiopulmonary bypass%Ultrasonography,doppler,transcranial
目的 研究颈动脉狭窄患者在冠状动脉旁路移植术(CABG)术中通过单纯提高心肺转流流量对脑血流和预后改善的意义.方法 选取2006年1月至2008年3月,51例接受CABG的冠状动脉粥样硬化性心脏病合并颈动脉狭窄患者,将其分为A、B两组.A组患者15例(单侧或双侧颈动脉狭窄≥50%),其中男性14例,女性1例,年龄(68.5±7.7)岁;B组36例(双侧颈动脉狭窄均<50%),其中男性34例,女性2例,年龄(62.4±10.2)岁.针对A组患者适当提高转机流量,并通过术中颈动脉超声监测观察脑血流改善效果,结合术后神经功能评分评价保护作用.结果 心肺转流中控制A组转流量高于B组,A组为(3.18±0.23)L·m-2·min-1,B组为(2.80±0.29)L·m-2·min-1(P=0.001).心肺转流过程中A组平均动脉压为(67.0±9.1)mm Hg(1 mm Hg=0.133kPa),高于B组的(59.0±7.1)mm Hg(P=0.009).两组大脑中动脉血流无明显差异(P=0.159).出院前患者神经心理学评分无明显差异.结论 颈动脉狭窄患者行CABG时,通过适当提高心肺转流灌注流量,可以明显改善病变侧脑血流,预防术后发生因术中脑缺血导致的神经心理并发症.
目的 研究頸動脈狹窄患者在冠狀動脈徬路移植術(CABG)術中通過單純提高心肺轉流流量對腦血流和預後改善的意義.方法 選取2006年1月至2008年3月,51例接受CABG的冠狀動脈粥樣硬化性心髒病閤併頸動脈狹窄患者,將其分為A、B兩組.A組患者15例(單側或雙側頸動脈狹窄≥50%),其中男性14例,女性1例,年齡(68.5±7.7)歲;B組36例(雙側頸動脈狹窄均<50%),其中男性34例,女性2例,年齡(62.4±10.2)歲.針對A組患者適噹提高轉機流量,併通過術中頸動脈超聲鑑測觀察腦血流改善效果,結閤術後神經功能評分評價保護作用.結果 心肺轉流中控製A組轉流量高于B組,A組為(3.18±0.23)L·m-2·min-1,B組為(2.80±0.29)L·m-2·min-1(P=0.001).心肺轉流過程中A組平均動脈壓為(67.0±9.1)mm Hg(1 mm Hg=0.133kPa),高于B組的(59.0±7.1)mm Hg(P=0.009).兩組大腦中動脈血流無明顯差異(P=0.159).齣院前患者神經心理學評分無明顯差異.結論 頸動脈狹窄患者行CABG時,通過適噹提高心肺轉流灌註流量,可以明顯改善病變側腦血流,預防術後髮生因術中腦缺血導緻的神經心理併髮癥.
목적 연구경동맥협착환자재관상동맥방로이식술(CABG)술중통과단순제고심폐전류류량대뇌혈류화예후개선적의의.방법 선취2006년1월지2008년3월,51례접수CABG적관상동맥죽양경화성심장병합병경동맥협착환자,장기분위A、B량조.A조환자15례(단측혹쌍측경동맥협착≥50%),기중남성14례,녀성1례,년령(68.5±7.7)세;B조36례(쌍측경동맥협착균<50%),기중남성34례,녀성2례,년령(62.4±10.2)세.침대A조환자괄당제고전궤류량,병통과술중경동맥초성감측관찰뇌혈류개선효과,결합술후신경공능평분평개보호작용.결과 심폐전류중공제A조전류량고우B조,A조위(3.18±0.23)L·m-2·min-1,B조위(2.80±0.29)L·m-2·min-1(P=0.001).심폐전류과정중A조평균동맥압위(67.0±9.1)mm Hg(1 mm Hg=0.133kPa),고우B조적(59.0±7.1)mm Hg(P=0.009).량조대뇌중동맥혈류무명현차이(P=0.159).출원전환자신경심이학평분무명현차이.결론 경동맥협착환자행CABG시,통과괄당제고심폐전류관주류량,가이명현개선병변측뇌혈류,예방술후발생인술중뇌결혈도치적신경심리병발증.
Objective To evaluate the effect of increasing eardiopulmonary bypass (CPB) flow volume in improving outcome of patients with carotid artery stenosis pedormed coronary artery bypass grafting (CABG) procedure. Methods Fifty-one patients data collected from January 2006 to March 2008 and divided into two groups (A and B) based on the degree of the carotid artery stennsis diagnosed by ultrasound. Group A included 15 cases with one or both carotid artery stenasis more than 50%, 14 male and 1 female, aged (68.5±7.7) years old, 14 with hypertension, 2 with diabetes, 6 with myocardial infarction, 3 with cerebral infarction. Group B included 36 cases with stenesis less than 50%, 34 male and 2 female, aged (62. 4 ± 10. 2) years old, 28 with hypertension, 7 with diabetes, 20 with myocardial infarction. Increasing CPB flow volume in A group to compare cerebral blood flow (CBF) within procedure in both groups. Results CPB flow volume in group A was much higher than it in group B(P=0.001). Mean aterial blood pressure in group A was (67.0±9. 1) nun Hg (1 mm Hg=0. 133 kPa), higher than group B (59.0±7. 1) mm Hg (P =0.009). There was no significant difference of CBF within procedure and neuropsychologic performance in both group as result. Conclusion For the patients presenting with carotid artery stenosis undergoing the procedure of CABG with CPB, increasing CPB flow volume could improve significantly diseased side cerebral blood flow and might reduce neurological complications.
