CAJ | 학술논문

目的探讨术中CT灌注成像(PCT)在颈动脉内膜切除术(CEA)中的应用价值.方法前瞻性纳入2012年3月至2012年7月收治的11例颈动脉中、重度狭窄患者,其中狭窄程度＞70％者8例,50％～ 70％者3例.所有患者均在术中CT手术室行CEA,在术前、后分别行PCT检查,获得脑血流量(CBF)、脑血容量(CBV)及达峰时间(TTP)伪彩图及定量数据,计算术侧与对侧的相对值rCBF、rCBV及rTTP.比较CEA前后2次PCT参数,并将其与体感诱发电位(SSEP)、微血管多普勒超声(MDU)等监测结果做比较.结果 (1)大脑前动脉供血区:各参数比较差异无统计学意义(P＞0.05).(2)大脑中动脉供血区:CEA前术侧与对侧CBF及CBV比较差异无统计学意义(P＞0.05),TTP延长(P ＜0.05);CEA后术侧与对侧比较,CBF及CBV明显增加(P＜0.05),TTP明显缩短(P＜0.05).CEA前后rCBF及rCBV增加,rTTP缩短,差异有统计学意义(P＜0.05).(3)PCT、SSEP及MDU比较:11例CEA中,PCT参数均有变化,均较术前好转,其中3例术后CBF增加超过70％；SSEP均未见明显变化,MDU变化明显.(4)术后CT均提示无高灌注性脑出血.结论术中PCT可通过rCBF、rCBV、rTTP能敏感反映CEA术后早期脑血流动力学变化,PCT将成为CEA术中一种重要的辅助监测手段.
목적 탐토술중CT관주성상(PCT)재경동맥내막절제술(CEA)중적응용개치.방법 전첨성납입2012년3월지2012년7월수치적11례경동맥중、중도협착환자,기중협착정도＞70％자8례,50％～ 70％자3례.소유환자균재술중CT수술실행CEA,재술전、후분별행PCT검사,획득뇌혈류량(CBF)、뇌혈용량(CBV)급체봉시간(TTP)위채도급정량수거,계산술측여대측적상대치rCBF、rCBV급rTTP.비교CEA전후2차PCT삼수,병장기여체감유발전위(SSEP)、미혈관다보륵초성(MDU)등감측결과주비교.결과 (1)대뇌전동맥공혈구:각삼수비교차이무통계학의의(P＞0.05).(2)대뇌중동맥공혈구:CEA전술측여대측CBF급CBV비교차이무통계학의의(P＞0.05),TTP연장(P ＜0.05);CEA후술측여대측비교,CBF급CBV명현증가(P＜0.05),TTP명현축단(P＜0.05).CEA전후rCBF급rCBV증가,rTTP축단,차이유통계학의의(P＜0.05).(3)PCT、SSEP급MDU비교:11례CEA중,PCT삼수균유변화,균교술전호전,기중3례술후CBF증가초과70％；SSEP균미견명현변화,MDU변화명현.(4)술후CT균제시무고관주성뇌출혈.결론 술중PCT가통과rCBF、rCBV、rTTP능민감반영CEA술후조기뇌혈류동역학변화,PCT장성위CEA술중일충중요적보조감측수단.
Objective To explore the clinical application of intraoperative perfusion computed tomography (PCT) in carotid endarterectomy (CEA).Methods 11 patients with moderate or severe carotid stenosis (the degree of stenosis greater than 70％ in 8 patients,50％～70％ in 3 patients) who underwent CEA in the operating room equipped with intraoperative CT were recruited prospectively from March to July 2012.PCT was performed twice in all cases before and after CEA.The color-coded parameter maps and quantitative data of cerebral blood flow (CBF),cerebral blood volume (CBV) and time to peak (TTP) were calculated,and the relative parameter values of rCBF,rCBV,rTTP based on comparison between operation side and contralateral side were acquired.The PCT parameters before and after CEA were compared.Combined with conventional monitoring methods such as somatosensory evoked potential(SSEP),microvascular doppler ultrasonography (MDU),the role of PCT were assessed.Results All the parameters in anterior communicating artery territory had no significant changes (P ＞ 0.05).In middle cerebral artery territory,only the TTP increased in operation side than in contralateral side while no difference was found in the CBF and CBV before CEA.After CEA,the CBF and CBV increased and TFP decreased in operation side than in contralateral side,and the rCBF and rCBV increased and rTTP decreased obviously comparison with those before CEA (P ＜ 0.05).Of the 11 patients,PCT parameters were improved in all cases.Three patients with the CBF increased more than 70％ after CEA were found.SSEP was normal and MDU abnormal in all cases.The routine CT scan revealed no cerebral hemorrhage.Conclusions Intraoperative PCT could sensitively detect the cerebral hemodynamic changes immediately after CEA through rCBF,rCBV and rTTP.Intraoperative PCT could be an important and adjuvant monitoring method in CEA.