初次开展颈动脉内膜切除术中经颅多普勒超声监测的经验总结

李文琦; 李军; 刘琨; 张红伟; 施丹伟; 游慧超

doi:10.7619/jcmp.20212371

初次开展颈动脉内膜切除术中经颅多普勒超声监测的经验总结

Summary of experience in transcranial Doppler ultrasound monitoring during initial performing carotid endarterectomy

摘要

摘要:
目的总结初次开展颈动脉内膜切除术(CEA)中经颅多普勒超声(TCD)监测的经验与教训。
方法回顾本院初次开展CEA术中TCD监测的方法，分析监测效果，总结经验与教训。
结果本组共实施CEA术中TCD监测34例，监测失败2例(5.9%)，均为消毒铺巾后TCD图像消失，其他32例均能及时向手术医师及麻醉师通报颅内血流情况。32例患者中，阻断颈内动脉后同侧大脑中动脉平均流速下降超过50%者11例(34.4%); 开放颈内动脉后同侧大脑中动脉平均流速超过基础值1倍者1例(3.1%); 开放颈内动脉时TCD监测显示颅内微栓子事件者9例(28.1%)。
结论术前做好个性化评估，术中妥善固定头架并做好实时监测记录，与手术医师及麻醉医师保持良好的沟通，是确保初次开展CEA术中TCD监测顺利进行的关键。

Abstract:
Objective To summarize the experience and lessons of transcranial Doppler ultrasonography (TCD) monitoring in primary carotid endarterectomy (CEA).
Methods The methods of intraoperative TCD monitoring of CEA for the first time in our hospital were reviewed, the monitoring effect was analyzed, and the experience and lessons were summarized.
Results A total of 34 patients underwent TCD monitoring during CEA, with the failure rate of monitoring of 5.9%(2 cases). All the TCD images disappeared after disinfection, and the other 32 cases were able to timely report the intracranial blood flow to the surgeons and anesthesiologists. In 32 patients, after occlusion of the internal carotid artery, the mean flow velocity of the ipsilateral middle cerebral artery decreased by more than 50% occurred in 11 patients (34.4%). After opening the internal carotid artery, the mean flow velocity more than one time of the baseline value occurred in 1 case (3.1%). TCD monitoring during internal carotid artery opening revealed microembolic events occurred in 9 cases (28.1%).
Conclusion The key to ensure the smooth progress of TCD monitoring during CEA operation is to make personalized evaluation before operation, properly fix the head frame during operation and make real-time monitoring records, and maintain good communication with surgeons and anesthesiologists.

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