主要为有症状的颈动脉疾病患者在清醒状态下接受颈动脉内膜切除术时的颈动脉残端压力及相关神经学变化。

Carotid artery stump pressure and associated neurological changes in predominantly symptomatic carotid artery disease patients undergoing awake carotid endarterectomy.

作者信息

Mulaudzi T V, Biccard B M, Robbs J V, Paruk N, Pillay B, Rajaruthnam P

机构信息

Durban Metropolitan Vascular Service, Durban, South Africa.

出版信息

Cardiovasc J Afr. 2009 Mar-Apr;20(2):116-8.

PMID:19421646

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3721289/

Abstract

AIM

To determine the mean carotid artery stump pressure (SP) at which patients develop neurological changes while undergoing awake carotid artery endarterectomy (CEA) under cervical block anaesthesia (CBA).

METHODS

A prospective analysis was carried out of patients undergoing awake CEA under CBA between February 2004 and April 2007. All patients had mean SP measured, with selective shunting on those who developed neurological symptoms on carotid artery clamping regardless of stump pressure. A ball connected to a pressure sensor was put in the patient inverted exclamation mark s contra-lateral hand.

RESULTS

Fifty-nine patients had awake CEA, 40 were males with a mean age of 64 years. Indications for CEA were asymptomatic high-grade stenosis in 12 (20%) patients and symptomatic stenosis in 47 (80%). Seven (12%) patients required shunting, one for transient ischaemic attack (TIA) and six for loss of consciousness. Six of these patients had presented with symptomatic disease. Taking the threshold of mean carotid SP of 50 mmHg as an indication for shunting, 22% (6/27) of patients with a mean SP of < 50 mmHg required shunting and only 3% (1/32) with a mean carotid SP of > 50 mmHg needed a shunt. This was not statistically significant. Using a mean carotid SP of < or = 40 mmHg as the threshold for shunting, 40% (4/10) of patients required shunting and 3% (1/31) with a mean carotid SP of > 40 mmHg required shunting. This was statistically significant. Thirteen (22%) patients were complicated by transient hoarseness of voice. One (2%) had a haematoma that required re-exploration. None of these patients had any major postoperative neurological or cardiological complications.

CONCLUSION

Even though the sample in this study was small, awake CEA under local anaesthesia was seen as a safe procedure. It would appear to be safe to use the mean SP of 40 mmHg as a threshold for selective shunting in CEA under general anaesthesia.

摘要

目的

确定在颈丛阻滞麻醉（CBA）下进行清醒颈动脉内膜切除术（CEA）时患者出现神经功能改变的平均颈动脉残端压力（SP）。

方法

对2004年2月至2007年4月期间在CBA下接受清醒CEA的患者进行前瞻性分析。测量所有患者的平均SP，对在颈动脉夹闭时出现神经症状的患者进行选择性分流，无论其残端压力如何。将一个连接压力传感器的球置于患者对侧手中。

结果

59例患者接受了清醒CEA，40例为男性，平均年龄64岁。CEA的指征为12例（20%）无症状重度狭窄患者和47例（80%）有症状狭窄患者。7例（12%）患者需要分流，1例因短暂性脑缺血发作（TIA），6例因意识丧失。这些患者中有6例有症状性疾病。以平均颈动脉SP 50 mmHg为分流指征，平均SP<50 mmHg的患者中有22%（6/27）需要分流，而平均颈动脉SP>50 mmHg的患者中只有3%（1/32）需要分流。这在统计学上无显著意义。以平均颈动脉SP≤40 mmHg为分流阈值，40%（4/10）的患者需要分流，而平均颈动脉SP>40 mmHg的患者中有3%（1/31）需要分流。这在统计学上有显著意义。13例（22%）患者出现短暂性声音嘶哑并发症。1例（2%）有血肿需要再次探查。这些患者均未出现任何重大术后神经或心脏并发症。