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目的:探讨对侧颈动脉狭窄程度对颈动脉内膜剥脱术(CEA)中转流管应用的影响。方法:回顾性分析390例颈动脉重度狭窄患者首次CEA治疗的临床资料。按对侧颈动脉狭窄程度分为对侧颈动脉狭窄<30%组179例,狭窄30%~69%组135例,狭窄≥70%组76例;分析3组术中收缩期颈动脉残端压(SCSP)变化、转流管应用情况和术后30 d并发症发生率及死亡率。结果:对侧颈动脉狭窄<30%组、30%~69%组、≥70%组术中SCSP分别为(55.7±18.2)mm Hg、(53.5±19.7)mm Hg、(46.3±15.2)mm Hg,术中转流管使用率分别为8.4%、7.4%、27.6%;对侧颈动脉狭窄<70%时SCSP及转流管使用率无明显变化(P>0.05),对侧颈动脉狭窄≥70%时SCSP明显下降(P<0.01),转流管使用率明显增加(P<0.01)。术后30 d内对侧颈动脉狭窄<70%组与狭窄≥70%组的患者在脑卒中、心脏并发症、死亡率方面均无显著差异(P>0.05)。结论 :对侧颈动脉狭窄程度对CEA中转流管应用的选择具有一定的预测价值,结合Willis环及椎-基底动脉状态的评估可进一步提高其预测作用。
Objective: To investigate the effect of contralateral carotid stenosis on the application of trocar in carotid endarterectomy (CEA). Methods: A retrospective analysis of 390 cases of severe carotid stenosis in patients with CEA for the first time clinical data. According to the degree of contralateral carotid artery stenosis, contralateral carotid artery stenosis in 179 cases, stenosis 30% ~ 69% in 135 cases, stenosis ≥70% in 76 cases; contralateral carotid artery stump Pressure (SCSP) changes, the application of the tundra and postoperative 30-day complication rate and mortality. Results: The SCSP in patients with contralateral carotid stenosis <30%, 30% -69%, and ≥70% were (55.7 ± 18.2) mm Hg, (53.5 ± 19.7) mm Hg, (46.3 ± 15.2) mm Hg, intraoperative use of the transfer tube were 8.4%, 7.4%, 27.6%; contralateral carotid artery stenosis <70% SCSP and the use of the tundish no significant change (P> 0.05), contralateral carotid stenosis ≥ The SCSP decreased significantly at 70% (P <0.01), and the use rate of tundra increased significantly (P <0.01). There were no significant differences in stroke, cardiac complications and mortality between contralateral carotid stenosis <70% and stenosis≥70% within 30 days after operation (P> 0.05). CONCLUSIONS: The degree of contralateral carotid artery stenosis has some predictive value for the choice of trochanter in CEA. The combination of Willis ring and vertebrobasilar artery status may further improve its predictive value.