血管超声在颈动脉内膜切除术前风险评估中的价值
贾凌云;雷娜;李娜;华扬;刘玉梅;刘蓓蓓;焦力群;马妍;王亚冰;李景植;周瑛华
【期刊名称】《中华神经外科杂志》 【年(卷),期】2017(033)006
【摘要】Objective To investigate the role of vascular ultrasonography in presurgical risk assessment of carotid endarterectomy (CEA).Methods A total of 562 patients with severe (70-99％) stenosis of carotid artery underwent CEA at Xuanwu Hospital from January 2013 to December 2015 and were enrolled into this retrospective study.Before CEA,the patient's vascular structures on surgical side and intracranial-external arterial hemodynamics were evaluated by the carotid color Doppler flow imaging (CDFI),transcranial color coded sonography (TCCS) and/or transcranial
Doppler
(TCD)
at
Department
of
Vascular
Ultrasonography.The factors related to postoperative (within 30 days) complications,including
hyperperfusion,newly
developed
cerebral
infarction and hemorrhage,were analyzed.Results The overall rate of postoperative complications including hyperperfusion (n =42),newly developed cerebral infarction (n =23) and hemorrhage (n =7) was 10.7％ (60/562 cases).Assessed by multivariate logistic analysis,closed anterior and posterior communicating arteries (OR =7.02,95％ CI:1.97-24.94,P =0.003) 、closed anterior communicating artery (OR =4.23,95％ CI:1.14-15.74,P =0.032),peak systolic velocity of the middle cerebral artery less
than 60 cm/s (OR =5.49,95％ CI:2.99-10.10,P ＜ 0.0001),at least 60 years of age (OR =5.29,95％ CI:2.14-13.05,P ＜ 0.0001),common carotid artery bifurcation higher than the level of C2 (OR =3.29,95％ CI:1.01-10.97,P =0.049),severe stenosis or occlusion of contralateral carotid artery were identified to be independent risk factors for postoperative complications within 30 days.Conclusion Comprehensive presurgical evaluation of vascular structures on the surgical side and hemodynamics by CDFI,TCCS,and/or TCD would help select patient candidates suitable for CEA and prevent postsurgical complications.%目的 探讨血管超声在颈动脉内膜切除术(CEA)前风险评估中的应用价值.方法 回顾性纳入2013年1月至2015年12月在首都医科大学宣武医院行CEA的重度(70％～99％)颈动脉狭窄患者562例.所有患者术前于血管超声诊断科采用颈动脉彩色多普勒超声(CDFI)、经颅彩色多普勒超声(TCCS)和(或)经颅多普勒超声(TCD),对术侧血管结构及颅内-外动脉血流动力学进行评估.分析CEA术后30 d内发生过度灌注综合征、新发脑梗死及脑出血并发症的相关影响因素.结果 562例患者中,CEA术后30 d内共60例(10.7％)出现终点事件,其中过度灌注综合征42例,新发脑梗死23例,脑出血7例.多因素Logistic回归分析显示,前、后交通动脉均未开放(OR=7.02,95％ CI:1.97 ～ 24.94,P=0.003)、前交通动脉未开放(OR=4.23,95％ CI:1.14 ～ 15.74,P=0.032)、术侧大脑中动脉收缩期峰值流速＜60 cm/s(OR=5.49,95％ CI:2.99 ～10.10,P＜0.0001)、年龄≥60岁(OR=5.29,95％ CI:2.14 ～ 13.05,P＜0.0001)、颈总动脉分叉位置高于C2水平(OR=3.29,95％ CI:1.01 ～ 10.97,P=0.049)、合并对侧颈动脉重度狭窄或闭
塞(OR=2.03,95％ CI:1.01～4.17,P=0.049)是CEA术后并发症的独立危险因素.结论 CEA术前联合应用颈动脉CDFI、TCCS和(或)TCD综合评估术侧血管病变局部结构和血流动力学,有助于选择适宜手术的患者,预防术后并发症的发生. 【总页数】4页(623-626)
【关键词】颈动脉内膜切除术;颈动脉狭窄;超声检查,多普勒;血流动力学;危险因素
【作者】贾凌云;雷娜;李娜;华扬;刘玉梅;刘蓓蓓;焦力群;马妍;王亚冰;李景植;周瑛华
【作者单位】100053北京,首都医科大学宣武医院血管超声诊断科;100053北京,首都医科大学宣武医院血管超声诊断科;100053北京,首都医科大学宣武医院血管超声诊断科;100053北京,首都医科大学宣武医院血管超声诊断科;100053北京,首都医科大学宣武医院血管超声诊断科;100053北京,首都医科大学宣武医院血管超声诊断科;100053北京,首都医科大学宣武医院神经外科;100053北京,首都医科大学宣武医院神经外科;100053北京,首都医科大学宣武医院神经外科;100053北京,首都医科大学宣武医院血管超声诊断科;100053北京,首都医科大学宣武医院血管超声诊断科 【正文语种】中文 【中图分类】 【文献来源】
https://www.zhangqiaokeyan.com/academic-journal-cn_chinese-journal-neurosurgery_thesis/0201237716936.html 【相关文献】
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血管超声在颈动脉内膜切除术前风险评估中的价值
