经颅多普勒超声监测在颈动脉内膜切除术中的应用价值：单中心回顾性研究

Clinical value of transcranial Doppler monitoring in carotid endarterectomy: a single-center retrospective study

摘要:

背景与目的 颈动脉内膜切除术（CEA）是治疗颈动脉狭窄的主要手段，但术中血流阻断及术后再灌注可能导致脑梗死及脑高灌注综合征（CHS）等神经系统并发症。如何在围手术期实时、动态评估脑灌注状态并指导个体化管理，仍缺乏统一有效的监测手段。本研究旨在评估经颅多普勒超声（TCD）监测在CEA围手术期安全性保障及远期预后改善中的临床价值。方法 回顾性分析2022年2月—2024年12月在中南大学湘雅二医院血管外科接受CEA的患者资料。根据围手术期是否应用TCD监测分为TCD组和非TCD组。比较两组患者的基线特征、围手术期处理、并发症发生情况及远期随访结局，并对TCD监测下脑血流动力学变化进行分析。结果 共纳入53例患者，其中TCD组25例，非TCD组28例。两组患者在年龄、性别及主要危险因素方面差异均无统计学意义（均P>0.05）。手术时间、住院时间及术中转流使用率在两组间差异均无统计学意义（均P>0.05）。术后30 d内，TCD组未发生短暂性脑缺血发作（TIA）及CHS，非TCD组分别发生2例TIA和3例CHS。随访期间，TCD组未发生不良事件，非TCD组发生2例不良事件。Kaplan-Meier分析显示，TCD组3.5年内无不良事件生存率明显高于非TCD组（P=0.047）。结论 CEA术中应用TCD监测与更优的远期无不良事件生存率显著相关。TCD可通过实时评估脑血流动力学变化，识别低灌注及脑高灌注高危患者，并指导围手术期精细化管理，具有重要的临床应用价值。

Abstract:

Background and Aims Carotid endarterectomy (CEA) is a primary treatment for carotid artery stenosis; however, intraoperative carotid clamping and postoperative reperfusion may lead to neurological complications such as cerebral infarction and cerebral hyperperfusion syndrome (CHS). An effective and standardized strategy for real-time, dynamic assessment of cerebral perfusion and individualized perioperative management is still lacking. This study aimed to evaluate the clinical value of transcranial Doppler (TCD) monitoring in improving perioperative safety and long-term outcomes in patients undergoing CEA.Methods Patients who underwent CEA at the Department of Vascular Surgery, the Second Xiangya Hospital of Central South University between February 2022 and December 2024 were retrospectively analyzed. According to the use of perioperative TCD monitoring, patients were divided into the TCD group and the non-TCD group. Baseline characteristics, perioperative management, complication rates, and long-term follow-up outcomes were compared between the two groups. Cerebral hemodynamic changes monitored by TCD were also analyzed.Results A total of 53 patients were included, with 25 in the TCD group and 28 in the non-TCD group. No significant differences were observed between the two groups in terms of age, sex, or major risk factors (all P>0.05). Operative time, length of hospital stay, and intraoperative shunt use were comparable between the two groups (all P>0.05). Within 30 days postoperatively, no transient ischemic attacks (TIA) or CHS occurred in the TCD group, whereas 2 cases of TIA and 3 cases of CHS were observed in the non-TCD group. During follow-up, no adverse events occurred in the TCD group, while 2 adverse events were recorded in the non-TCD group. Kaplan-Meier analysis demonstrated that the 3.5-year event-free survival rate was significantly higher in the TCD group than in the non-TCD group (P=0.047).Conclusion The use of TCD monitoring during CEA is significantly associated with improved long-term event-free survival. By enabling real-time assessment of cerebral hemodynamics, TCD facilitates identification of patients at high risk for cerebral hypoperfusion and hyperperfusion and guides refined perioperative management, thereby providing substantial clinical value.