颈动脉狭窄手术后视网膜动脉压变化的研究

摘要

目的 测量评价颈动脉狭窄(CAS)手术后视网膜中央动脉压的变化.方法 前瞻性临床研究50位重度颈动脉狭窄患者,其中施行颈动脉狭窄支架植入术18例,颈动脉狭窄内膜剥脱术32例.所有患者均于CAS手术前和手术后1d使用配置有Goldmann接触镜的新型视网膜血管血压计(ODM)测量视网膜中央动脉舒张压(diastCRAP),比较CAS手术前后diastCRAP的差异.结果 CAS手术前手术侧眼平均diastCRAP为(37.8±13.04) mmHg(1 mmHg =0.133 KPa),非手术侧眼平均diastCRAP为(44.62±15.51) mmHg,CAS手术后手术侧眼平均diastCRAP为(59.01±10.70) mmHg(1 mmHg=0.133 KPa),非手术侧眼平均diastCRAP为(44.22±15.04) mmHg.CAS手术侧眼手术后diastCRAP较手术前显著升高(t=1.877,P=0.000),差异有统计学意义.CAS手术前后非手术侧眼diastCRAP差异无统计学意义(t=2.023,P=0.895).结论 利用新型的ODM可以观察和评价CAS手术对于改善视网膜中央动脉血管灌注的效果.%Objective To evaluate the change of central retinal artery pressure after the surgery for carotid artery stenosis.Methods The prospective clinical study included fifty patients with severe carotid artery stenosis who received carotid stenting (CAS) (n =18) or carotid endarterectomy (CEA) (n =32) treatment.Of all subjects the diastolic central retinal artery pressure (diastCRAP) of both eyes were tested before and 1 day after the carotid surgery using a new Goldmann contact lens associated ophthalmodynamometer.The preoperative and postoperative diastolic central retinal artery pressure were compared.Results Before carotid artery stenosis surgery,the mean diastolic central retinal artery pressure in operation side was(37.8 ± 13.04) mmHg,and in no operation side was(44.62 ± 15.51) mmHg.After the carotid artery stenosis surgery,the mean diastolic central retinal artery pressure in operation side was (59.01±10.70) mmHg,and in no operation side was(44.22 ± 15.04) mmHg.In operation side,the postoperative diastolic central retinal artery pressure was significantly higher than the preoperative one (t =1.877,P =0.000) and in no operation side,there was no statistically significant difference in diastCRAP between before and after the surgery (t =2.023,P =0.895).Conclusion A simple and new Goldmann contact lens associated ophthalmodynamometer can observe and assess the effect of carotid artery stenosis surgery on improving the central retinal artery perfusion.