CAJ | 학술논문

目的：分析颈动脉内膜切除术( CEA)治疗颈动脉次全或完全闭塞术中超声监测血管结构、血流动力学改变与手术再通的相关性。方法回顾性纳入2005年1月-2014年1月在首都医科大学宣武医院经DSA确诊为颈动脉闭塞性病变,并接受CEA治疗的患者共107例。根据术中超声检查结果,分为血流再通组86例和未通组21例。对比分析两组患者术前及术中大脑中动脉的血流速度及搏动指数,记录术中颈动脉血管异常、血管残余狭窄率、再通患者病变血管内径及血流速度及搏动指数。结果(1)颈动脉再通患者术中与术前患侧MCA的收缩期峰值流速(PSV)分别为(82±32)和(60±17) cm/s,平均流速(MV)分别为(50±19)和(42±13) cm/s,血管搏动指数(PI)分别为0．97±0．25和0．67±0．14,术中较术前明显升高,差异均有统计学意义(均P<0．01)；未通患者术中与术前MCA的PSV分别为(46±20)和(63±21) cm/s,EDV分别为(24±13)和(34±12) cm/s,MV分别为(32±16)和(44±15) cm/s,术中均较术前明显降低,差异均有统计学意义(均P<0．01),但PI术中与术前比较差异无统计学意义(0．70±0．18和0．67±0．15, P=0．317)。(2)再通组病变血管内径术中较术前明显增宽[(3．4±0．9)和(0．6±0．4) mm,P=0．000]。术中超声检查发现再通者86例中血管结构轻度异常13例,未再通者均为血管结构显著异常。结论术中颈动脉超声结合经颅多普勒超声监测脑血流,可有效判断颈动脉血管结构及脑血管血流动力学的改善程度,及时指导术中二次修复。
목적：분석경동맥내막절제술( CEA)치료경동맥차전혹완전폐새술중초성감측혈관결구、혈류동역학개변여수술재통적상관성。방법회고성납입2005년1월-2014년1월재수도의과대학선무의원경DSA학진위경동맥폐새성병변,병접수CEA치료적환자공107례。근거술중초성검사결과,분위혈류재통조86례화미통조21례。대비분석량조환자술전급술중대뇌중동맥적혈류속도급박동지수,기록술중경동맥혈관이상、혈관잔여협착솔、재통환자병변혈관내경급혈류속도급박동지수。결과(1)경동맥재통환자술중여술전환측MCA적수축기봉치류속(PSV)분별위(82±32)화(60±17) cm/s,평균류속(MV)분별위(50±19)화(42±13) cm/s,혈관박동지수(PI)분별위0．97±0．25화0．67±0．14,술중교술전명현승고,차이균유통계학의의(균P<0．01)；미통환자술중여술전MCA적PSV분별위(46±20)화(63±21) cm/s,EDV분별위(24±13)화(34±12) cm/s,MV분별위(32±16)화(44±15) cm/s,술중균교술전명현강저,차이균유통계학의의(균P<0．01),단PI술중여술전비교차이무통계학의의(0．70±0．18화0．67±0．15, P=0．317)。(2)재통조병변혈관내경술중교술전명현증관[(3．4±0．9)화(0．6±0．4) mm,P=0．000]。술중초성검사발현재통자86례중혈관결구경도이상13례,미재통자균위혈관결구현저이상。결론술중경동맥초성결합경로다보륵초성감측뇌혈류,가유효판단경동맥혈관결구급뇌혈관혈류동역학적개선정도,급시지도술중이차수복。
Objective To analyze the correlations of vascular structure, hemodynamic changes and surgical recanalization of carotid endarterectomy ( CEA) for the treatment of subtotal or complete occlusion of carotid artery. Methods A total of 107 patients with carotid artery occlusive disease diagnosed at Beijing Xuanwu Hospital,Capital Medical University received CEA therapy from January 2005 to January 2014 and were enrolled retrospectively. According to the findings of introperative ultrasound,they were divided into either a recanalization group (n=86) or a non-recanalization group (n=21). Preoperative and intraoperative carotid artery diameter and blood flow velocity were compared and analyzed with carotid ultrasonography. Intraoperative detected vascular abnormalities, residual vascular stenosis rate, blood flow velocity and pulsatility index of the ipsilateral middle cerebral artery ( MCA) were documented. Results (1) The peak systolic velocity (PSV) (82 ± 32 cm/s and 60 ± 17 cm/s),mean velocity (MV) (50 ± 19 cm/s and 42 ±13cm/s),and pulsatility index (PI) (0. 97 ± 0. 25 and 0. 67 ± 0. 14) on the ipsilateral MCA in patients of carotid artery recanalization before and after procedure were significantly higher than those during the procedure. There were significant differences (all P=0. 000). In patients failed to recanalize,the intraoperative and preoperative PSV,EDV,and MV of MCA were 46 ± 20 cm/s and. 63 ± 21 cm/s,24 ± 13 cm/s and 34 ± 12 cm/s, and 32 ± 16 cm/s and 44 ± 15 cm/s,respectively. They were reduced more significantly during the procedure than those after procedure. There were significant differences ( all P=0. 000 ) . But there was no significant difference in PI (0. 70 ± 0. 18 and 0. 67 ± 0. 15) compared with that before procedure (P=0. 317). (2) The diseased vascular diameter of the recanalization group was significantly widened (0. 6 ± 0. 4 mm vs. 3. 4 ± 0. 9 mm,P=0. 000) compared with before procedure. The overall recanalization rate was 80. 4% (86/107). Intraoperative ultrasound revealed that 13 patients had mild abnormal vascular structures among the recanalized patients. The non-recanalized patients had significantly abnormal vascular structure. Conclusion Intraoperative carotid ultrasound in combination with transcranial Doppler (TCD) for monitoring cerebral blood flow may effectively identify the carotid structure and the degree of cerebral hemodynamic improvement,and timely guide the secondary repair.