Lee Jonggeun, Huh Up, Song Seunghwan, Chung Sung Woon, Sung Sang Min, Cho Han Jin
Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Department of Neurology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Ann Vasc Dis. 2016;9(4):295-299. doi: 10.3400/avd.oa.16-00049. Epub 2016 Oct 11.
Carotid endarterectomy (CEA) is the standard treatment modality for the prevention of stroke in patients with carotid stenosis. This study reports our experiences during CEA with routine awake tests under regional anesthesia (RA) combined with light sedation by dexmedetomidine infusion. We retrospectively reviewed 23 patients who had undergone CEA between April 2013 and June 2015. All patients underwent the awake test during CEA with cervical plexus block and light sedation by continuous dexmedetomidine infusion. Mean operation and clamp times were 108.5 ± 20.1 min and 30.1 ± 6.9 min, respectively. Selective shunt placement was performed in three patients (13.0%). There were no cases of perioperative stroke, myocardial infarction, or death. There were no occurrences of residual stenosis, thrombosis, or dissection. One patient had a hypoglossal nerve injury but fully recovered before discharge. Mean (± standard deviation) hospital stay was 7.5 ± 2.6 days. There were no incidences of death, stroke, or restenosis during a mean follow-up period of 9.2 ± 8.8 months. RA with dexmedetomidine infusion appears to be a safe and feasible option. A lower shunt placement rate and favorable patient outcomes were observed following the awake test during CEA.
颈动脉内膜切除术（CEA）是预防颈动脉狭窄患者中风的标准治疗方式。本研究报告了我们在区域麻醉（RA）联合右美托咪定输注轻度镇静下进行CEA时的经验。我们回顾性分析了2013年4月至2015年6月期间接受CEA的23例患者。所有患者在CEA期间均接受了清醒测试，采用颈丛阻滞并通过持续输注右美托咪定进行轻度镇静。平均手术时间和夹闭时间分别为108.5±20.1分钟和30.1±6.9分钟。3例患者（13.0%）进行了选择性分流置入。围手术期无中风、心肌梗死或死亡病例。无残余狭窄、血栓形成或夹层发生。1例患者出现舌下神经损伤，但出院前完全恢复。平均（±标准差）住院时间为7.5±2.6天。在平均9.2±8.8个月的随访期内，无死亡、中风或再狭窄发生。输注右美托咪定的RA似乎是一种安全可行的选择。CEA期间清醒测试后观察到较低的分流置入率和良好的患者预后。
