Regina Guido, Angiletta Domenico, Impedovo Giovanni, De Robertis Giovanni, Fiorella Marialuisa, Carratu' Maria Rosaria
Department of Vascular Surgery, University of Bari, Bari, Italy.
J Vasc Surg. 2009 Jan;49(1):99-102; discussion 103. doi: 10.1016/j.jvs.2008.08.049. Epub 2008 Nov 22.
The incidence of cranial and cervical nerve injury during carotid endarterectomy (CEA) ranges from less than 7.6% to more than 50%. Lesions are mainly due to surgical maneuvers such as traction, compression, tissue electrocoagulation, clamping, and extensive dissections. The use of dexamethasone (DEX) and its beneficial effects in spinal cord injuries have already been described. We investigated whether DEX could also be beneficial to minimize the incidence of cranial and cervical nerve injury during CEA.
To evaluate whether dexamethasone is able to reduce the incidence of cranial nerve injuries.
From March 1999 through April 2006, 1126 patients undergoing CEA because of high-grade carotid stenosis were enrolled and randomized by predetermined randomization tables into two groups. The first group, "A", included 586 patients that all received an intravenous administration of dexamethasone following a therapeutic scheme. The second group, "B", included 540 control subjects that received the standard pre- and postoperative therapy. All patients were submitted to a deep cervical plexus block, eversion carotid endarterectomy, and selective shunting. Three days after the operation, an independent neurologist and otorhinolaryngologist evaluated the presence of cranial nerve deficits. All patients (group A and group B) showing nerve injuries continued the treatment (8 mg of dexamethasone once in the morning) for 7 days and were re-evaluated after 2 weeks, 30 days, and every 3 months for 1 year. Recovery time took from 2 weeks to 12 months, with a mean time of 3.6 months. The chi(2) test was used to compare the two groups and to check for statistical significance.
The incidence of cranial nerve dysfunction was higher in group B and the statistical analysis showed a significant effect of dexamethasone in preventing the neurological damage (P = .0081). The incidence of temporary lesions was lower in group A and the chi(2) test yielded a P value of .006. No statistically significant differences were found when comparing the effect of dexamethasone in men and women. In addition, dexamethasone had no statistically significant effect on the incidence of permanent cranial nerve injuries. Finally, no adverse effect related to the administration of dexamethasone was observed.
Perioperative administration of dexamethasone is effective in minimizing the incidence of temporary cranial nerve injuries during CEA.
颈动脉内膜切除术（CEA）期间颅神经和颈神经损伤的发生率在7.6%以下至50%以上不等。损伤主要归因于手术操作，如牵拉、压迫、组织电凝、钳夹和广泛解剖。地塞米松（DEX）的使用及其在脊髓损伤中的有益作用已有相关描述。我们研究了DEX是否也有助于降低CEA期间颅神经和颈神经损伤的发生率。
评估地塞米松是否能够降低颅神经损伤的发生率。
从1999年3月至2006年4月，1126例因重度颈动脉狭窄接受CEA的患者入组，并通过预先确定的随机分组表随机分为两组。第一组“A组”，包括586例患者，所有患者均按照治疗方案接受地塞米松静脉注射。第二组“B组”，包括540例对照受试者，接受标准的术前和术后治疗。所有患者均接受颈深丛阻滞、外翻式颈动脉内膜切除术和选择性分流术。术后3天，由一名独立的神经科医生和耳鼻喉科医生评估是否存在颅神经功能缺损。所有显示神经损伤的患者（A组和B组）继续治疗（每天早晨一次给予8mg地塞米松）7天，并在2周、30天以及1年内每3个月进行重新评估。恢复时间为2周至12个月，平均时间为3.6个月。采用卡方检验比较两组并检验统计学意义。
B组颅神经功能障碍的发生率更高，统计分析显示地塞米松在预防神经损伤方面具有显著效果（P = 0.0081）。A组临时损伤的发生率较低，卡方检验得出的P值为0.006。比较地塞米松在男性和女性中的效果时，未发现统计学上的显著差异。此外，地塞米松对永久性颅神经损伤的发生率没有统计学上的显著影响。最后，未观察到与地塞米松给药相关的不良反应。
围手术期给予地塞米松可有效降低CEA期间临时颅神经损伤的发生率。
