The Effectiveness of TCD Combined with SEP-Guided Intraoperative Individualized Blood Pressure Management in Patients Undergoing Carotid Endarterectomy

CHEN Shu; ZHANG Shan; WU Honggang; ZHENG Niandong

doi:10.14033/j.cnki.cfmr.2025.30.005

Abstract：Objective:To investigate the efficacy of intraoperative individualized blood pressure management guided by transcranial Doppler ultrasound(TCD)combined with somatosensory evoked potential(SEP)monitoring in patients undergoing carotid endarterectomy(CEA).Method:A total of 100 patients with CEA admitted to Leshan People's Hospital from July 2023 to December 2024 were selected and divided into a control group of 50 cases and an observation group of 50 cases using computerized randomization.The control group received conventional blood pressure management,while the observation group received intraoperative individualized blood pressure management guided by TCD combined with SEP.The perioperative indicators,middle cerebral artery mean blood flow velocity(Vm)values,systolic blood pressure changes,and postoperative complication rates of the two groups were observed.Result:There was no statistically significant difference between the two groups in terms of carotid artery clamping,anesthesia,and surgical time(P>0.05).The myocardial oxygen consumption,norepinephrine,and nitroglycerin usage in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the Vm values and systolic blood pressure of the middle cerebral artery between the two groups at T0,T3,and T4(P>0.05).The Vm values and systolic blood pressure of the middle cerebral artery in the observation group were lower than those in the control group at T1 and T2,and the difference was statistically significant(P<0.05).Compared with the control group,the observation group showed a greater decrease in Vm values of the middle cerebral artery at T1 and T2 and a smaller increase in systolic blood pressure,with statistically significant differences(P<0.05).The incidence of postoperative cognitive dysfunction,postoperative restenosis,and secondary thrombosis was lower in the observation group than in the control group,with statistically significant differences(P<0.05).Conclusion:The TCD-guided intraoperative individualized blood pressure management strategy in combination with SEP has demonstrated significant clinical efficacy in CEA surgery,enhancing surgical safety and reducing postoperative complications.