Nedey C, Barjoud H, Chatelard P, Pizza E, Brunon A M, Adeleine P, Sabben F, Ganichot F, Jurus C, Chatel C
Département d'Anesthésie-Réanimation, Clinique du Tonkin, Villeurbanne, France.
Ann Vasc Surg. 1995 May;9(3):247-51. doi: 10.1007/BF02135283.
Of 135 carotid artery reconstructions performed under general anesthesia in 127 patients (mean age 68 years), 119 were performed with continuous intraoperative Doppler recording of the middle cerebral artery. This investigation was impossible in nine (6.7%) cases because of the absence of a visible temporal window, and results were deemed uninterpretable in six (4.5%) additional cases. The goals of this study were to test the feasibility and reliability of transcranial Doppler monitoring in the evaluation of intracranial perfusion and to determine the risk of cerebral ischemia during carotid artery clamping. The two outcome parameters measured were mean velocity and percentage of decreased flow in the middle cerebral artery during clamping. Patients were divided into four groups based on variations in these parameters. Groups I and IIA (low risk) represented 69.7% of cases, group IIB (significant risk) represented 21.9%, and group III (major risk) represented 8.4%. Transcranial Doppler monitoring appears to be a reliable means of observing middle cerebral artery flow during carotid surgery and in our opinion provides objective criteria for determining the need for an indwelling shunt. Accordingly, in this study no neurologic complications imputable to clamping were observed. Transcranial Doppler monitoring can also be used to ensure correct functioning of the shunt and to detect intraoperative embolic complications.
在127例患者（平均年龄68岁）接受全身麻醉进行的135例颈动脉重建手术中，119例术中对大脑中动脉进行了连续多普勒记录。9例（6.7%）因无可见颞窗而无法进行此项检查，另有6例（4.5%）结果被认为无法解读。本研究的目的是测试经颅多普勒监测在评估颅内灌注中的可行性和可靠性，并确定颈动脉夹闭期间脑缺血的风险。测量的两个结果参数是夹闭期间大脑中动脉的平均流速和血流减少百分比。根据这些参数的变化将患者分为四组。I组和IIA组（低风险）占病例的69.7%，IIB组（显著风险）占21.9%，III组（重大风险）占8.4%。经颅多普勒监测似乎是观察颈动脉手术期间大脑中动脉血流的可靠方法，我们认为它为确定是否需要留置分流管提供了客观标准。因此，在本研究中未观察到可归因于夹闭的神经并发症。经颅多普勒监测还可用于确保分流管功能正常，并检测术中栓塞并发症。
