电邮这篇文章 区域麻醉下颈动脉内膜切除术中的颈动脉交叉钳位不耐受
- 作者: Majd P.1, Galkin P.1, Tayeh M.1, Herzmann T.1, Gores M.1, Kalmykov E.1, Ahmad W.2
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隶属关系:
- Evangelical Hospital Bergisch Gladbach
- University Hospital of Cologne
- 期: 卷 29, 编号 1 (2021)
- 页面: 66-72
- 栏目: Original study
- URL: https://bakhtiniada.ru/pavlovj/article/view/60620
- DOI: https://doi.org/10.23888/PAVLOVJ202129166-72
- ID: 60620
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详细
在外科动脉内膜切除术中，需要颈动脉交叉夹持以进行动脉切开和斑块清除。颈动脉阻断减少了流向Willis环的血流量，一些患者对颈内动脉（ICA）暂时性闭塞表现出不耐受。
目的。本研究论证了颈动脉交叉钳位不耐受（CCI）患者局部麻醉的安全性以及预测这种情况的危险因素。
材料和方法。回顾性分析发现，2019年1月至2020年12月期间接受颈动脉内膜切除术的所有患者（n=53，29名男性，年龄56-90岁（中位数78）），手术适应症为70%-99%的ICA狭窄或症状性狭窄。
外科手术。在胸锁乳突肌的前缘做一个切口。颈总动脉（CCA）从周围组织中分离出来，并向分叉处延伸。之后，分离颈内动脉和颈外动脉。静脉注射肝素（5000U），收缩压升高并保持在160mm Hg以上。接着，进行交叉钳位耐受性试验60s。使用夹钳期间，对患者的神经系统进行仔细观察。若出现颈动脉交叉钳位不耐受（CCI），插入临时分流器并继续手术。动脉切开术从颈总动脉开始，持续到颈内动脉。完全清除斑块，用补片覆盖动脉切开处。在完成缝合之前，夹钳被部分移除，利用血流冲洗碎屑后可松开外动脉和总动脉。最后移除颈内动脉钳。
结果。8例接受交叉钳夹耐受试验的患者表现为不耐受。所有这些病例的手术均通过分流继续进行。进一步的手术过程并不复杂。院内死亡率为零，仅1例发生短暂性脑缺血发作。冠状动脉疾病（CAD）[优势比（OR）12.65，95% 置信区间（CI）1.43–112.50]、脑血管事件史[OR 10.50，95% CI 1.83–60.30]、对侧狭窄70%或以上[OR 26.66，95% CI 2.29–304.37]与CCI和分流的必要性有显著关联。其余因素与不耐症无明显关联。
结论。区域麻醉是鉴别CCI患者和安全手术的安全方法。对侧ICA狭窄和脑血管事件史是预测CCI的重要因素。
作者简介
Payman Majd
Evangelical Hospital Bergisch Gladbach
Email: mir.majd@uk-koeln.de
ORCID iD: 0000-0002-5835-8318
Chief physician, Specialist in surgery, Specialist in vascular surgery, Endovascular surgeon
德国, Bergisch Gladbach North Rhine-Westphalia, GermanyPeter Galkin
Evangelical Hospital Bergisch Gladbach
Email: p.galkin@uk-koeln.de
ORCID iD: 0000-0003-2666-5337
Senior physician Dr. Med., Specialist in vascular surgery
德国, Bergisch Gladbach North Rhine-Westphalia, GermanyMahmoud Tayeh
Evangelical Hospital Bergisch Gladbach
Email: m.tayeh@uk-koeln.de
ORCID iD: 0000-0001-5460-8562
Assistant Doctor
德国, Bergisch Gladbach North Rhine-Westphalia, GermanyThomas Herzmann
Evangelical Hospital Bergisch Gladbach
Email: t.herzmann@uk-koeln.de
ORCID iD: 0000-0002-7442-9825
Michael Gores
Evangelical Hospital Bergisch Gladbach
Email: m.gores@uk-koeln.de
ORCID iD: 0000-0002-1015-3698
Egan Kalmykov
Evangelical Hospital Bergisch Gladbach
编辑信件的主要联系方式.
Email: info@helios-international.com
ORCID iD: 0000-0001-6784-2243
MD, PhD
德国, Bergisch Gladbach North Rhine-Westphalia, GermanyWael Ahmad
University Hospital of Cologne
Email: wael.ahmad@uk-koeln.de
ORCID iD: 0000-0001-5090-3468
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