McDowell H A, Gross G M, Halsey J H
Department of Surgery, University of Alabama, Birmingham 35294.
Ann Surg. 1992 May;215(5):514-8; discussion 518-9. doi: 10.1097/00000658-199205000-00014.
Intraoperative transcranial Doppler monitoring of cerebral ischemia during carotid clamping under general anesthesia was done in 238 carotid artery operations, mostly endarterectomy. Depending on the severity of reduction of middle cerebral artery mean velocity, patients were classified as no, mild, or severe ischemia at clamping. With a carotid shunt, velocity was always in the "no ischemia" category during shunting. For patients with no ischemia, stroke was significantly lower without a shunt (2/175 no shunt versus 2/12 shunt). For mild ischemia, shunting did not affect the stroke rate (1/20 no shunt versus 0/9 shunt). For severe ischemia, strokes were less frequent with a shunt (4/9 no shunt versus 0/13 shunt). Intraoperative electroencephalogram predicted most, but not all severely ischemic cases. Carotid back pressure correlated with Doppler velocity, but transcranial Doppler was more helpful. Transcranial Doppler is a new and valuable technique in carotid surgery.
在238例颈动脉手术（大多为内膜切除术）中，于全身麻醉下对颈动脉夹闭期间的脑缺血进行了术中经颅多普勒监测。根据大脑中动脉平均血流速度降低的严重程度，将患者在夹闭时分为无缺血、轻度缺血或重度缺血。使用颈动脉分流管时，分流期间血流速度始终处于“无缺血”类别。对于无缺血的患者，不使用分流管时的卒中发生率显著更低（未使用分流管组175例中有2例，使用分流管组12例中有2例）。对于轻度缺血患者，分流不影响卒中发生率（未使用分流管组20例中有1例，使用分流管组9例中有0例）。对于重度缺血患者，使用分流管时卒中发生频率更低（未使用分流管组9例中有4例，使用分流管组13例中有0例）。术中脑电图可预测大多数但并非所有重度缺血病例。颈动脉背压与多普勒血流速度相关，但经颅多普勒更具帮助。经颅多普勒是颈动脉手术中的一项新的且有价值的技术。
