Staszkiewicz W, Antepowicz W, Madycki G, Witkowski K, Raciborski W, Gawlikowska D
Kliniki Chirurgii Naczyniowej Centrum Medycznego Kształcenia Podyplomowego w Warszawie.
Wiad Lek. 1997;50 Suppl 1 Pt 2:45-7.
We evaluated the role of intraoperative transcranial Doppler sonography in improvement of carotid endarterectomy results. We analyzed the outcome of 38 carotid endarterectomies (CEA) performed in 22 female and 16 male patients with symptomatic carotid stenosis, aged between 43 and 78 years (av. 61.8 years). Constant measurements of peak and average velocity (Va) were taken during following stages of CEA:-after anaesthesia--during 120 s crossclamp test, -after shunt insertion (5 patients),-immediately after and 5 min after crossclamp release.
We obtained following values of Va in particular stages of CEA:-after anaesthesia 0.54 m/s (0.38-1.08),-during 120 s crossclamp test 0.25 m/s (0.12-0.58),-after shunt insertion 0.47 m/s (0.32-0.78),-immediately after crossclamping 0.72 m/s (0.51-1.40),-5 min. after crossclamp release 0.62 m/s (0.42-1.27). In 2 cases no blood flow velocity increase was found after shunt insertion. The immediate correction of shunt positioning was done. In 2 other patients no hemodynamic effect after CEA was detected (no blood flow velocity increase in MCA and at the same time, no neurological impairments were noticed). After quick investigation inferior carotid artery kinking above the arteriotomy site and its stenosis after suturing were found. Both of these abnormalities were removed and since that moment the blood flow velocity in MCA increased, in comparison with preoperative values.
intraoperative transcranial doppler monitoring 1) allows to identify any kind of blood flow disturbance in MCA during each stage of CEA which appears before neurological impairment, 2) gives the possibility of shunt functioning evaluation, 3) enables to avoid intraoperatively unpredictable situations that may result in imminent cerebral ischemia, 4) 70% decrease of blood flow velocity in MCA is the indication for shunt insertion, 5) proved to be very helpful in (in 10% of our material) improving the results of all carotid endarterectomies.
我们评估了术中经颅多普勒超声在改善颈动脉内膜切除术结果中的作用。我们分析了22名女性和16名男性有症状颈动脉狭窄患者（年龄在43至78岁之间，平均61.8岁）接受的38例颈动脉内膜切除术（CEA）的结果。在CEA的以下阶段持续测量峰值和平均速度（Va）：-麻醉后-在120秒的夹闭试验期间，-分流器插入后（5例患者），-夹闭释放后立即及5分钟后。
我们在CEA的特定阶段获得了以下Va值：-麻醉后0.54米/秒（0.38 - 1.08），-在120秒夹闭试验期间0.25米/秒（0.12 - 0.58），-分流器插入后0.47米/秒（0.32 - 0.78），-夹闭后立即0.72米/秒（0.51 - 1.40），-夹闭释放后5分钟0.62米/秒（0.42 - 1.27）。2例患者分流器插入后未发现血流速度增加。立即对分流器位置进行了校正。另外2例患者CEA后未检测到血流动力学效应（大脑中动脉血流速度未增加，同时未发现神经功能障碍）。快速检查后发现动脉切开部位上方颈内动脉扭结及其缝合后狭窄。这两种异常均被消除，自那时起大脑中动脉血流速度与术前值相比增加。
术中经颅多普勒监测1）能够在CEA的每个阶段识别出大脑中动脉中在神经功能障碍出现之前出现的任何类型的血流紊乱，2）提供了评估分流器功能的可能性，3）能够避免术中可能导致即将发生脑缺血的不可预测情况，4）大脑中动脉血流速度降低70%是分流器插入的指征，5）在（我们资料的10%中）被证明对改善所有颈动脉内膜切除术的结果非常有帮助。
