抗癫痫药物对颈内动脉内膜剥脱术后脑高灌注综合征的防治体会_West China Medical Journal

Authors：

 冯大磊 ^1,2 , 叶明 ¹ , 焦力群 ¹

1. ;
2. ;

Corresponding author：

Keywords：

颈内动脉内膜剥脱术; 围手术期; 脑高灌注综合征; 抗癫痫药物

DOI：

10.7507/1002-0179.201600473

Video：

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目的探讨颈内动脉内膜剥脱术（CEA）围手术期应用抗癫痫药物对防治CEA后脑高灌注综合征（CHS）的效果。方法选择2012年4月-10月有CHS危险因素的CEA患者75例，随机分为治疗组（37例）和对照组（38例）。对照组患者应用抗血小板药物、他汀类药物治疗，治疗组患者在对照组的基础上，于术前3 d开始口服丙戊酸钠缓释片，观察其术后1周、3个月的临床表现。结果治疗组患者术后1周出现CHS相关表现11例（29.7%），无癫痫发作（0.0%）；术后3个月CHS相关表现全部消失，仍无癫痫发作。对照组患者术后1周出现CHS相关表现23例（60.5%），癫痫发作3例（7.9%）；术后3个月后13例（35.1%）仍有轻度CHS相关表现，无癫痫发作。两组比较差异有统计学意义（P < 0.05）。结论围手术期应用抗癫痫药物可有效降低CEA后出现CHS相关表现和癫痫发作概率。

Citation： 冯大磊, 叶明, 焦力群. 抗癫痫药物对颈内动脉内膜剥脱术后脑高灌注综合征的防治体会. West China Medical Journal, 2016, 31(10): 1720-1722. doi: 10.7507/1002-0179.201600473 Copy

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1. Wilkinson JT, Adams HP, Wright CB. Convulsions after carotid endarterectomy[J]. JAMA, 1980, 244(16): 1827-1828.
2. Wagner WH, Cossman D, FarberA, et al. Hyperperfusion syndrome after carotid endarterectomy[J]. Ann Vasc Surg, 2005, 19(4): 479-486.
3. Barnett HJ, Elisziw M, Meldrum HE. Evidence based cardiology: prevention of ischaemic stroke[J].BMJ, 1999, 318(7197): 1539-1543.
4. Stmdt TM, Sharbrough FW, Piepgras DG, et al. Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral ischemia[J]. Mayo Clin Proc, 1981, 56(9): 533-543.
5. 李萌, 郑宇, 张鸿祺, 等.颈动脉内膜切除术后高灌注综合征的诊断与治疗[J].中国脑血管病杂志, 2005, 2(8): 348-351.
6. Meyers PM, Higashida RT, Phatouros CC, et al. Cerebral hyperperfusion syndrome after percutaneous transluminal stenting of the craniocervical arteries[J]. Neurosurgery, 2000, 47(2): 335-343.
7. Ramírez-Moreno JM, Constantino-Silva AB, Gómez-Baquero MJ, et al. Cerebral hyperperfusion syndrome following a carotid endartereetomy[J]. Rev Neurol, 2010, 51(11): 699-701．.
8. 樊新颖, 徐格林, 刘新峰.脑过度灌注综合征的监测[J].中华神经医学杂志, 2006, 5(9): 968-970.
9. 周定标.颈动脉内膜切除[M].北京:人民军医出版社, 2005: 56-58.
10. Ivens S, Kaufer D, Flores LP, et al. TGF-beta receptor-mediated albumin uptake into astrocytes is involved in neocortical epileptogenesis[J]. Brain, 2007, 130(Pt 2): 535-547.
11. 刘伟, 张茁.脑高灌注综合征[J].中华老年心脑血管病杂志, 2012, 14(1): 56-58.

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West China Medical Journal

抗癫痫药物对颈内动脉内膜剥脱术后脑高灌注综合征的防治体会

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