全麻下颈动脉内膜剥脱术的麻醉体会

目的:评价颈动脉内膜剥脱术(CEA)麻醉疗效,以及经颅多普勒超声(TCD)、微血管多普勒超声(MVD)应用的价值,以及适合颈动脉内膜剥脱术的适合麻醉方法。方法:回顾性分析苏州大学附属一医院脑卒中中心2012年5月至2013年5月所进行的颈动脉内膜剥脱术治疗的19名颅外颈动脉狭窄患者的资料。患者临床症状均伴有不同程度的脑缺血症状。颈动脉狭窄程度2例中度狭窄,17例重度狭窄。所有手术操作均全麻下在显微镜下操作。1例采用补片成形。18例术中采用TCD及MVD监测下完成,1例未采用超声监测。结果:手术成功率为100%,无死亡率。术前脑缺血症状术后患者均有恢复。未发现过度灌注的并发症。麻醉效果达到预期目的。结论:颈动脉内膜剥脱术在多普勒超声MVD及TCD监测下治疗颅外颈动脉狭窄是一种安全、有效的措施;全身麻醉下行CEA手术安全可靠。

Experience of Operation for Carotid Endarterectomy under General Anesthesia

Objective:To evaluate the general anesthesia effect of carotid endarterectomy (CEA) on extracranial carotid artery stenosis and the role of transcranial Doppler (TCD)and Microvascular Doppler (MVD) in carotid endarterectomy, and further to discuss the suitable anesthesia method.Methods:From May 2012 to May 2013, 19 patients were selected in the First Affiliated Hospital of Suzhou University. All patients had symptoms of cerebral ischemia. Two patients had middle carotid artery stenosis and the others had severe carotid artery stenosis. All patients were under microsurgery. Only one patient had angioplasty with arterial patch. TCD and MVD monitoring was used in the surgery of 18 patients while 1 patient was not.Results:Surgery was successful in all patients. Cerebral ischemic symptoms were improved to a certain degree in all the 19 preoperative symptomatic patients. No hyperperfusion was found in these patients. The anesthesia achieved the desired effect.Conclusion:Carotid endarterectomy is a safe and effective procedure for treatment of extraeranial carotid artery stenosis. MVD and TCD monitoring is valuable in microsurgery. General anesthesia is safe and reliable in operation of CEA.