摘要
目的探讨诱导性升降压在颈动脉内膜斑块切除术(carotid endarterectomy,CEA)中的安全性及有效性。方法回顾性分析2012年8月至2018年8月于国内多中心收治的1486例颈动脉狭窄患者,经筛选共纳入1448例患者符合人组标准,在CEA术中均使用诱导性升降压技术。结果共纳入1448例患者,手术侧颈动脉重度狭窄患者占87.8%。评估代偿血管情况,平均手术时间(51.8±6.1)min,颈内动脉阻断时间(11.4±3.1)min。经诱导性升压后,所有患者残端压均升高,其中1438例(99.3%)>50mmHg。监测脑电氧饱和度,阻断前未升压时,术侧较对侧明显降低[(56%±3%)比(64%±4%),P<0.05];诱导性升压后,术侧rSO2较对侧rSO2低,但差异无统计学意义[(66%±3%)比(70%±2%),P>0.05];颈动脉开放后,术侧rSO2较对侧rSO2低,但差异无统计学意义[(68%±5%)比(69%±3%),P>0.05]。围手术期共发生脑梗死2例,同侧脑出血1例,对侧脑出血1例,心肌梗死2例。结论CEA术中使用诱导性升降压技术可起到临时脑保护作用.初步证明了诱导性升降压技术的安全性及有效性。
Objective :To evaluate the safety and efficacy of induced hypotension and hypotension in carotid endarterectomy (CEA).Methods Data of 1486patients who underwent CEA in muhicenters from Aug 2012to Aug 2018were retrospectively analyzed.After screening,a total of 1448patients met the inclusion criteria.Induced hypertension and hypotension was used in all thees patients.Results 87.8% of the patients were with severe carotid stenosis.The average operative time was (51.8±6.1)min,and the internal carotid artery clamping time was (11.4+3.1 )min.After induced hypertension,the stump pressure were higher than that before,of which 1438(99.3%)were greater than 50mmHg.Monitoring of EEG oxygen saturation showed that the value of ipsilateral rSO2 was significantly lower than that of the contralateral [(56%±3%)vs.(64%±4%),P <0.05]before induced hypertension.After induced hypertension and clamp removal,the value of ipsilateral rSO2 was lower than that of the contralateral,but there was not significant difference (all P >0.05).Perioperative cerebral infarction occurred in 2 cases,ipsilateral cerebral hemorrhage in 1 case,contralateral cerebral hemorrhage in 1 case and myocardial infarction in 2 cases.Conclusion The technique of induced hypotension and hypotension play a temporary role in brain protection for patients undergoing CEA.This study demonstrated the safety and effectiveness of induced hypertension and hypotension technique.
作者
蒋庆君
柏骏
季相国
曲乐丰
李文波
颜玉峰
柴东喆
柳尧林
李清勇
曹忠文
Jiang Qingiun;Bai Jun;Ji Xiangguo;Qu Lefeng;Li Wenbo;Yan Yufeng;Chai Dongzhe;Liu Yaolin;Li Qingyong;Cao Zhongwen(Department of Vascular and Endovascular Surgery,Changzheng Hospital,Second Military Medical University,Shanghai 200003,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2018年第12期994-997,共4页
Chinese Journal of General Surgery
基金
国家自然科学基金(81870347)
国家自然科学基金(81700408)
上海市科委科技支撑项目基金(16411966500)
上海高校特聘教授(东方学者)基金(GZ2016008)
上海领军人才基金(035).
关键词
颈动脉内膜切除术
大脑动脉环
诱导性升/降压
残端压
Endarterectomy ,carotid
Circle of Willis
Induced hypertension/hypotension
Stump pressure
