颈动脉内膜切除术时用于预测分流的残端压力和经颅多普勒检查
Stump pressure and transcranial Doppler for predicting shunting in carotid endarterectomy.
作者信息
Belardi P, Lucertini G, Ermirio D
机构信息
Vascular Surgery, Università degli Studi di Genova, Largo Rosanna Benzi 8, 16132 Genoa, Italy.
出版信息
Eur J Vasc Endovasc Surg. 2003 Feb;25(2):164-7. doi: 10.1053/ejvs.2002.1823.
OBJECTIVES
to compare stump pressure (SP) and transcranial Doppler (TCD) with neurologic monitoring during carotid endarterectomy (CEA).
MATERIALS
one hundred and forty-seven CEAs performed under local anaesthesia.
METHODS
neurologic monitoring and SP were performed in all cases, while mean velocity of the middle cerebral artery (mvMCA) by TCD was done in 140/147 (95%) cases. Shunts were applied in all cases on the basis of neurologic monitoring. The following haemodynamic criteria have been compared to neurologic monitoring: (a) <25 mmHg SP; (b) <50 mmHg SP; (c) < or =10 cm/s mvMCA after carotid occlusion; (d) > or =70 decrease of mvMCA after carotid occlusion. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for each haemodynamic criterion.
RESULTS
shunt was used in 18/147 (12.2%) cases. With regards to <25 mmHg SP, < or =50 mmHg SP, < or =10 cm/s mvMCA after carotid occlusion, and > or =70 decrease of mvMCA after carotid occlusion, sensitivity resulted 33, 89, 80 and 80%, respectively. Specificity resulted 96, 82, 97 and 96%, respectively. Positive predictive value resulted 55, 41, 75 and 71%, respectively. Negative predictive value 91, 98, 98 and 98%, respectively. Accuracy resulted 88, 76, 89 and 94%, respectively.
CONCLUSIONS
none of the haemodynamic criteria by SP and TCD resulted absolutely reliable in predicting the need for carotid shunt.
目的
比较颈动脉内膜切除术（CEA）期间残端压力（SP）、经颅多普勒（TCD）与神经功能监测的情况。
材料
147例在局部麻醉下进行的CEA手术。
方法
所有病例均进行神经功能监测和SP测量，140/147（95%）例通过TCD测量大脑中动脉平均流速（mvMCA）。所有病例均根据神经功能监测情况应用分流管。将以下血流动力学标准与神经功能监测进行比较：（a）SP<25 mmHg；（b）SP<50 mmHg；（c）颈动脉阻断后mvMCA≤10 cm/s；（d）颈动脉阻断后mvMCA下降≥70%。计算每个血流动力学标准的敏感性、特异性、阳性预测值、阴性预测值和准确性。
结果
18/147（12.2%）例使用了分流管。对于SP<25 mmHg、SP≤50 mmHg、颈动脉阻断后mvMCA≤10 cm/s以及颈动脉阻断后mvMCA下降≥70%，敏感性分别为33%、89%、80%和80%。特异性分别为96%、82%、97%和96%。阳性预测值分别为55%、41%、75%和71%。阴性预测值分别为91%、98%、98%和98%。准确性分别为88%、76%、89%和94%。
结论
SP和TCD的血流动力学标准在预测颈动脉分流管需求方面均并非绝对可靠。
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