Romner B, Bergqvist D, Lindblad B
Department of Neurosurgery, University Hospital, Lund, Sweden.
Acta Neurochir (Wien). 1993;121(3-4):130-4. doi: 10.1007/BF01809263.
Twenty-one patients undergoing carotid endarterectomy were investigated by simultaneous intra-operative measurements of carotid stump pressure (CSP) and transcranial Doppler (TCD) flow velocity in the middle cerebral artery. The relationship between the two methods was evaluated as well as the potential benefits of the intraoperative transcranial Doppler monitoring technique. Clamping of the carotid artery resulted in a significant decrease in TCD flow velocity in the ipsilateral middle cerebral artery as well as in CSP. There was no correlation between relative change in CSP and the simultaneously obtained relative change in TCD flow velocity during carotid clamping (r = 0.31, p = 0.26). The insertion of an intra-operative shunt was followed by an increase in flow velocity compared to the clamping value. One patient with clear TCD signs of a re-occlusion (a sudden decrease in flow velocity) during closure of the wound, demonstrated a thrombosis at re-exploration. TCD gives information of the collateral cerebral circulation during carotid clamping and is an alternative monitoring technique during carotid endarterectomy. The method is useful intraoperatively for detecting embolic events as well as thrombosis during wound closure. Further studies are necessary to clarify the critical change in flow velocity during clamping when the use of a peroperative shunt is indicated.
对21例行颈动脉内膜切除术的患者，术中同时测量颈动脉残端压力（CSP）和大脑中动脉的经颅多普勒（TCD）血流速度进行研究。评估了这两种方法之间的关系以及术中经颅多普勒监测技术的潜在益处。颈动脉夹闭导致同侧大脑中动脉的TCD血流速度以及CSP显著降低。颈动脉夹闭期间，CSP的相对变化与同时获得的TCD血流速度的相对变化之间无相关性（r = 0.31，p = 0.26）。与夹闭值相比，术中插入分流管后血流速度增加。1例患者在伤口闭合期间有明确的TCD再闭塞征象（血流速度突然降低），再次探查时显示有血栓形成。TCD可提供颈动脉夹闭期间大脑侧支循环的信息，是颈动脉内膜切除术期间的一种替代监测技术。该方法在术中对于检测栓塞事件以及伤口闭合期间的血栓形成很有用。需要进一步研究以明确在指示使用术中分流管时夹闭期间血流速度的临界变化。
