Xue Zhe, Peng Dingwei, Sun Zhenghui, Wu Chen, Xu Bainan, Wang Fuyu, Zhou Dingbiao, Dong Tianxiang
Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland).
Department of Radiology, Chinese PLA General Hospital, Beijing, China (mainland).
Med Sci Monit. 2016 Sep 22;22:3362-3369. doi: 10.12659/msm.897356.
BACKGROUND This study aimed to evaluate the changes in perfusion computed tomography (PCT) parameters in carotid endarterectomy (CEA), and to discuss the use of intraoperative PCT in CEA. MATERIAL AND METHODS Sixteen patients with carotid stenosis who also underwent CEA with intraoperative CT were recruited in this study. We calculated quantitative data on cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and the relative parameter values, including relative CBF (rCBF), relative CBV (rCBV), and relative TTP (rTTP). The role of PCT was assessed and compared to conventional monitoring methods. RESULTS There were no significant differences in any of the parameters in the anterior cerebral artery (ACA) territory (P>0.05). In the middle cerebral artery (MCA) territory, the CBF and CBV increased and TTP decreased in the operated side during CEA; the rCBF and rCBV increased and the rTTP decreased significantly (P<0.05). In 16 patients, CT parameters were improved, SSEP was normal, and MDU was abnormal. In 3 patients, CBF increased by more than 70% during CEA. Relative PCT parameters are sensitive indicators for detecting early cerebral hemodynamic changes during CEA. Cerebral hemodynamics changed significantly in the MCA territory during CEA. CONCLUSIONS Intraoperative PCT could be an important adjuvant monitoring method in CEA.
背景 本研究旨在评估颈动脉内膜切除术（CEA）中灌注计算机断层扫描（PCT）参数的变化，并探讨术中PCT在CEA中的应用。材料与方法 本研究纳入了16例患有颈动脉狭窄且接受了术中CT检查的CEA患者。我们计算了脑血流量（CBF）、脑血容量（CBV）、达峰时间（TTP）的定量数据以及相对参数值，包括相对CBF（rCBF）、相对CBV（rCBV）和相对TTP（rTTP）。评估了PCT的作用并与传统监测方法进行比较。结果 大脑前动脉（ACA）区域的任何参数均无显著差异（P>0.05）。在大脑中动脉（MCA）区域，CEA期间手术侧的CBF和CBV增加，TTP降低；rCBF和rCBV增加，rTTP显著降低（P<0.05）。16例患者中，CT参数改善，体感诱发电位（SSEP）正常，运动诱发电位（MDU）异常。3例患者在CEA期间CBF增加超过70%。相对PCT参数是检测CEA期间早期脑血流动力学变化的敏感指标。CEA期间MCA区域的脑血流动力学发生了显著变化。结论 术中PCT可能是CEA中一种重要的辅助监测方法。
