颈动脉内膜剥脱术中脑电双频指数与脑血流速度的相关性  

The correlation of bispectral index and cerebral blood flow velocity during carotid endarterectomy

作　　者：赵文度[1] 欧阳川[1] 霍岩松[1] 杨宝慧[2] 张亮[1] 裴馨[1] 何琛[1] 

机构地区：[1]首都医科大学附属北京安贞医院麻醉科,100029 [2]首都医科大学附属北京安贞医院体外循环科,100029

出　　处：《临床麻醉学杂志》2014年第4期366-369,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨颈动脉内膜剥脱术（CEA）中脑电双频指数（BIS）和脑血流速度的相关性。方法择期CEA患者35例，年龄54-80岁。采用经颅多普勒（TCD）监测和记录入室时（T1）、麻醉诱导后气管插管前（T2）、游离颈动脉10min（T3）、阻断颈动脉5min（T4）、放置颈动脉转流管5min（T5）、开放颈动脉5min（T6）及60min（T7）时大脑左、右两侧脑血流峰值速度（Vp）、平均速度（Vm），以及相应时点的BIS值，分析相关性。结果35例患者均采集BIS值，其中17例患者采集Vp、Vm。T2、B、T4、T7时BIS与Vp、Vm呈显著正相关（P〈0．01）；两侧Vp、Vm在T7时均呈显著正相关（r=0．542和r=0．649，P〈0．05）。T2时CEA侧BIS值与Vm呈显著正相关（r=0．498，P〈0．05）；T1时非CEA侧BIS值与Vp呈显著正相关（r=0．556，P〈0．05）。T3、T4时CEA侧BIS值的变化与Vp的变化呈显著负相关（r=-0．584，P〈0．05），而非CEA侧无显著相关性。结论在CEA中，CEA侧与非CEA侧之间，其BIS值的变化因受到麻醉和脑血流量变化的双重影响而不完全一致。BIS值可反映脑血流速度的变化，在人手术室（非CEA侧）和麻醉诱导（CEA侧）时它们的变化方向一致，而在阻断颈动脉早期（CEA侧）的变化方向相反。Objective To evaluate the correlation between bispectral index （BIS） and cerebral blood flow velocity during carotid endarterectomy（CEA）. Methods Thirty-five patients （age 54-80） scheduled for CEA were enrolled in the transcranial doppler （TCD） study. The bilateral middle cerebral artery peak velocity （Vp）, mean velocity （Vm） and BIS were measured via TCD at the following time points： entering operation room （T1）, after the induction of anesthesia and before intubation （T2）, separation of the common carotid arteries （T3）, occlusion of common carotid arteries for 5 mins （T4）, placement of vascular shunt in carotid arteries for 5 mins （T5）, opening carotid artery for 5 rains （T6） and 60 mins （T7） respectively. Results All of the 35 patients were recorded BIS value, and 17 patients of Vp and Vm were collected. The correlation between BIS and Vp or Vm was significantly positive at T2, T3, T4, T7 （P〈0. 01）. The correlation analysis between Vp and Vm on CEA side and non-CEA side showed highly positive correlation at T7 （r=0. 542, r=0. 649, P〈0. 05）. IBIS and Vm were positively correlated at T2 （r= 0.498, P〈0. 05）. On the non-CEA side, BIS and Vp were positively correlated at T1 point（r=0. 556, P〈0.05）. There was a significant negative correlation between BIS and Vp at T3 and T4 at CEA side but not non-CEA side（r=-0. 584, P〈0. 05）. Conclusion BIS is not completely consistent on the CEA side and non-CEA side during carotid endarterectomy because of anesthesia and cerebral blood flow changes. BIS may reflect the changes of cerebral blood flow velocity. The changes of BIS are the same at non-CEA side and CEA side, but the op- posite in the early period of carotid artery occlusion.

关 键 词：颈动脉内膜剥脱术 脑电双频指数 脑血流速度 超声多普勒 

分 类 号：R614[医药卫生—麻醉学]