Theclinical Research Of The Transcranial Doppler Guide The Selecting Of The Carotid Shunt

Objective:The purpose of this researching is the use of Transcranial Doppler (Transcranial Doppler,TCD) in dynamic monitoring of cerebral blood flow during CEA to assess the compensatory ability of cerebral blood vessels, the inference of cerebral hypoperfusion may occur in situations, whether use shunt technique in improving surgery success rates, to reduce perioperative occurrence of ischemic stroke.Material and methods:Select from January 2006 to June 2010 in Tianjin people's Hospital vascular depertmentt symptomatic patients with carotid artery stenosis and accept the CEA, randomly selected from 60 patients, all of the patients after general anesthesia, Transcranial Doppler (TCD) of lateral temporal window probe after monitoring of side PSV Middle cerebral artery, EDV, MV, and PI. Surgery revealed CCA, ECA and ICA near the end, before the blocked CCA, inject heparin (0.5mg/Kg)anticoagulation, test occlusion of internal carotid artery, distal after occlusion of the measuringcatheter into the ICA, measure distal internal carotid artery stump pressure to 40mmHg as boundary value. At the same time blocking the determination of the affected side of the brain after carotid artery in the PSV, EDV, MV and PI. Comparing the measured value and the value of preoperative, measurement of carotid artery open again after the operation is complete before the above indicators and compare values. Using SPSS 13 statistics software for analysis, shunt group and non-shunt group,befer and after blocking brain in the artery PSV, and EDV, and MV, and PI and MV changes rate for comparison used paired t test, all patients operation Qian and operation Hou brain in the artery PSV,EDV,MV,PI for comparison, used paired t test, p< 0.05For statistically significant differences.Results:After blocking CCA in operation,49 cases of patients before and after blocking the average decline in blood flow velocity of middle cerebral artery does not exceed 50%, Not place the shunt:47 cases sp>40 mmHg, openblocking Hou monitoring 1 cases patients brain in the artery appears different blood components of high strength signal consider for thrombosis, the patients appears brain infarction given treatment improved; 2 cases patients SP<40 mmhg,36 mmhg,33mmhg,1 case sp>40mmHg, consider for blocking distal ICA blood flow perfusion pressure and ICA branch brain in the arteriosclerosis, brain in the artery perfusion pressure obvious decline caused by operation in the placed shunt monitoring to 2 cases patients brain in the artery appears different blood components of high strength signal consider for thrombosis, operation appears stretch tongue skew and limb muscle force decline phenomenon, given anticoagulant and improve brain cycle treatment improved. Shunt group before and after blocking the carotid artery in patients with PSV, EDV, MV, PI dropped significant, statistically. Non-shunt group before and after blocking the carotid artery in patients with PSV, EDV, MV, PI, MV loss is not significant, statistically. Open to all patients with middle cerebral artery after carotid artery surgery side PSV, EDV, MV, PI more before all higher, statistically.2 cases of postoperative patients with middle cerebral artery MV over 100cm/s, consider high-perfusion of the brain, giving improved after treatment with mannitol intracranial pressure. No Perioperative mortality of all patients. All patient follow-up 6-24 months, an average of 16 months, does not occur side cerebral infarction. Conclusion:1. The present group case of determination of middle cerebral artery in the affected side PSV, after EDV, MV, PI and preoperative compare these indicators can be found an obvious improvement, that CEA operation effect is good, CEA is present for carotid atherosclerosis in patients with TIA, and effective treatment of cerebral infarction induced by avoiding. Surgical carotid shunt can effectively guarantee after occlusion of the carotid artery of patients with cerebral vascular perfusion, lower because the Blocked carotid arteries causing cerebral perfusion pressure decline caused by ischemic stroke, but when you place the shunt easy to produce sandwich, incidence of cerebral infarction induced by thrombus shedding and plaque. 2. Combination literature and this group test, CEA with TCD can dynamic no trauma of monitoring brain blood flow of changes, as TCD monitoring with side brain in the artery average blood flow speed below blocking of 50%, prompted operation side brain in the artery area brain blood flow perfusion compensation ability insufficient, long time blocking this side neck within artery, will caused with side brain in the artery area brain deficiency blood, turn occurs brain infarction, should using shunt. to avoid above complications of the carotid artery of patients with cerebral vascular perfusion, blocking before and after brain in the artery average blood flow speed decline rate does not over 50%, can think-patient side brain vascular collateral compensation good, without using go flow tube. This avoids the brain of cerebral infarction caused by insufficient collateral compensative, while avoiding the bypass pipe caused by improper use of perioperative complications occur.3. before and after operation of Transcranial Doppler monitoring can be found for the formation of thrombus and cerebral phenomena of excessive perfusion, timely symptomatic treatment, reduce the occurrence of peri-operative complications.