Archie J P, Feldtman R W
Arch Surg. 1982 Mar;117(3):319-22. doi: 10.1001/archsurg.1982.01380270037008.
To define cerebral perfusion pressure during carotid clamping, carotid back and jugular venous pressures were measured in 100 consecutive carotid endarterectomies in 92 patients. The mean +/- 1 SD was 40.5 +/- 16.0 mm Hg for carotid back pressure, 11.8 +/- 4.8 mm Hg for jugular venous pressure, and 28.7 15.4 mm Hg for cerebral perfusion pressure. A number of variables affect jugular venous pressure, including jugular vein compression, patient position, and the anesthetic type. The lower the carotid back pressure, the more likely that back pressure alone is poor determinant of cerebral perfusion pressure and, hence, of the adequacy of collateral cerebral blood flow. To accurately use the carotid back or stump pressure method. The jugular venous pressure must also be measured, and the cerebral perfusion pressure must be calculated. Based on established safe levels of cerebral blood flow, it is probable that patients who undergo a carotid endarterectomy with a cerebral perfusion pressure of less than 18 mm Hg have cerebral ischemia and may require a shunt. Selective shunting, based on the cerebral perfusion pressure, gave a 1% mortality and 2% permanent neurologic deficit in this series.
为了确定颈动脉夹闭期间的脑灌注压，在92例患者连续进行的100例颈动脉内膜切除术中测量了颈动脉回血压力和颈静脉压力。颈动脉回血压力的平均值±1标准差为40.5±16.0 mmHg，颈静脉压力为11.8±4.8 mmHg，脑灌注压力为28.7±15.4 mmHg。许多变量会影响颈静脉压力，包括颈静脉受压、患者体位和麻醉类型。颈动脉回血压力越低，仅靠回血压力越不可能成为脑灌注压的良好决定因素，因此也无法确定脑侧支血流是否充足。为了准确使用颈动脉回血或残端压力法，还必须测量颈静脉压力，并计算脑灌注压。根据已确定的安全脑血流水平，接受颈动脉内膜切除术时脑灌注压低于18 mmHg的患者很可能发生脑缺血，可能需要分流。在本系列中，基于脑灌注压的选择性分流导致1%的死亡率和2%的永久性神经功能缺损。
