中国脑血管病杂志2012，Vol.9Issue(9)：472-476,5.DOI:10.3969/j.issn.1672-5921.2012.09.005
经颅多普勒超声经眼窗监测脑血流动力学在颈动脉内膜切除术中的应用价值
Values of hemodynamics monitoring via ocular window with transcranial Doppler during carotid endarterectomy
摘要
Abstract
Objective To investigate the validity and reliability of transcranial color Doppler (TCD) via the ocular window when the temporal window pentrated poor during carutid endarlereclomy (CEA) . Methods Eight patients were monitored with TCD via the ocular window during CEA. TCD was used to evaluate the patency of collateral circulation before procedure and it was confirmed by DSA. In-traoperative cerebral blood flow was monitored, the parameters such as the peak systolic velocity (PSV) , end diastolic velocity (EDV) , mean velocity ( MV) and pulse index (PI) of the ipsilateral ophthalmic artery (OA) and/or carotid siphon ( CS) at the different time points were record after anesthesia, before and after carotid occlusion, after shunt placement, and patency of carotid artery. Results ① 4 of 8 patients used shunt because of the adverse compensation of communicating artery. OA and CS were monitored with dual-depth monitoring in 3 patients; CS was monitored alone in 2, and OA was monitored alone in 3. ②'Compared to the carotid arteries before clipping,the PSV, MV, EDV and PI of OA decreased sig- nificantly after clipping. The differences were statistically significant (P < 0. 05). PI of OA increased significantly after the patency of carotid blood flow (P <0.05) ; compared to before clipping the carotid arteries, the PSV of CS decreased significantly (P <0. 05) , but there was no significant difference in comparing the blood flow after patency with all the parameters before clipping ( P > 0. 05 ). ③The surgical monitoring was successful in 7 patients. Only one patient had cerebral infarction 1 week after procedure and 7 had good prognosis. Conclusion Monitoring the cerebral blood flow changes via ocular window during CEA may effectively solve the problem of the poor temporal window penetration. Monitoring the blood flow parameters of ipsilateral OA and CS with dual-depth intermittent monitoring are the ideal ways. For patients with incomplete compensation in anterior communicating artery and/or the posterior communicating artery, the use of shunt is recommended. It may prevent intraoperative cerebral ischemia and reduce the occurrence of postoperative stroke.关键词
颈动脉内膜切除术/超声检查,多普勒,经颅/经眼窗监测Key words
Carotid artery endarterectomy/Ultrasound examination,Doppler, transcranial/Transorbital monitoring引用本文复制引用
刘玉梅,华扬,刘蓓蓓,孟秀峰,杨洁,贾凌云,唐旸烁,李景植..经颅多普勒超声经眼窗监测脑血流动力学在颈动脉内膜切除术中的应用价值[J].中国脑血管病杂志,2012,9(9):472-476,5.基金项目
北京市卫生局青年基金资助项目(QN2010-003) （QN2010-003）
