颈静脉球血氧饱和度、体感诱发电位和运动诱发电位评估颅内动脉瘤夹闭术患者脑缺血发生准确性的比较  

Comparison of accuracy of jugular venous oxygen saturation, somatosensory evoked potentials and motor evoked potentials in estimation of occurrence of intraoperative cerebral ischemia in patients undergoing clipping of intracranial aneurysm

作　　者：惠晶[1] 崔伟华[1] 刘莉[2] 王明然[2] 乔慧[2] 张东[3] 王硕[3] 韩如泉[1] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100050 [2]北京市神经外科研究所 [3]首都医科大学附属北京天坛医院神经外科

出　　处：《中华麻醉学杂志》2012年第9期1111-1114,共4页Chinese Journal of Anesthesiology

基　　金：北京市卫生系统高层次卫生技术人才建设专项经费（2009-3-19）;北京市科委科技新星资助项目（2007874）

摘　　要：目的比较颈静脉血氧饱和度（SjvO2）、体感诱发电位（SSEPs）和运动诱发电位（MEPs）评估颅内动脉瘤夹闭术患者脑缺血发生的准确性。方法拟行颅内动脉瘤夹闭术患者43例，性别不限，年龄18～64岁，BMI20～25kg／m2，ASA分级I或Ⅱ级。气管插管后机械通气，采用丙泊酚-瑞芬太尼全凭静脉麻醉，分别于记录动脉瘤夹闭或载瘤动脉临时阻断前、动脉瘤夹闭或载瘤动脉临时阻断后1、3、10、20、30min时采集颈内球部血样，测定SjvO2，并于上述时点记录SSEPs和MEPs的波幅及潜伏期，分别记录3种指标判断术中脑缺血发生情况，记录术后3d内神经缺损情况，以发生神经缺损作为判断术中脑缺血发生的金标准。结果术中发生脑缺血14例。SjvO2评估术中脑缺血发生的灵敏度和特异度分别为71％和93％（P〈0．01）；SSEPs评估术中脑缺血发生的灵敏度和特异度分别为71％和62％（P〈0．05）；以MEPs波幅降低或潜伏期延长作为判断脑缺血发生标准时，评估术中脑缺血发生的灵敏度和特异度分别为79％和52％（P〉0．05），以MEPs波幅消失作为判断脑缺血发生标准时，评估术中脑缺血发生的灵敏度和特异度分别为57％和93％（P〈0．05）。结论SjvO2和SSEPs评估颅内动脉瘤夹闭术患者脑缺血发生的灵敏度较高，而SjvO2和MEPs评估脑缺血发生的特异度较高，提示SjvO2是评估脑缺血发生的可靠指标。Objective To compare the accuracy of jugular venous oxygen saturation （SjvO2）, somatosen- sory evoked potentials （SSEPs） and motor evoked potentials （MEPs） in estimation of the occurrence of intraopera- tive cerebral ischemia in patients undergoing clipping of intracranial aneurysm. Methods Forty-three ASA I or H patients of both sexes, aged 18-64 yr, with a body mass index of 20-25 kg/m2 , undergoing clipping of intracra- nial aneurysm, were studied. Anesthesia was induced with sufentanil, rocuronium and propofol. The patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with remifentanil and propofol. Blood samples were taken from the jugular bulb for detection of SjvO2 before aneurysm clipping or temporary occlusion of parent artery and at 1, 3, 10, 20 and 30 min after clipping aneurysm or temporary occlusion of parent artery. The amplitude and latency of SSEPs and MEPs were recorded simultaneously. The occmence of cerebral ischemia esti- mated by SjvO2 , SSEPs and MEPs was recorded. The condition of nerve defect was recorded within 3 days after operation and the gold standard of cerebral ischemia was defined as the occurrence of nerve defect. Results Among 43 patients, 14 cases were diagnosed as having brain ischemia. The sensitivity and specificity of SjvO2 in estimation of the occurrence of intraoperative brain ischemia were 71% and 93%, respectively （ P 〈 0.01 ）. The sensitivity and specificity of SSEPs in estimation of the occurrence of intraoperative brain ischemia were 71% and 62% , respectively （P 〈 0.05）. When the diagnostic criterion of cerebral ischemia was defined as a decrease in the amplitude of MEPs or prolongation of the latency MEPs, the sensitivity and specificity of MEPs in estimation of the occurrence of intraoperative brain ischemia were 79% and 52% , respectively （ P 〉 0.05）. When the diagnos- tic criterion of cerebral ischemia was defined as a loss of the amplitude of MEPs, the sensitivity and specificity of MEPs in estimati

关 键 词：颈静脉球 血氧测定法 诱发电位 躯体感觉 诱发电位 运动监测 手术中 脑缺血 

分 类 号：R614[医药卫生—麻醉学]