体感诱发电位和脑电图多模态监测在颈动脉内膜切除术中的应用  

The application of somatosensory evoked potential and electroencephalographymultimodal monitoring in carotid endarterectomy

作　　者：王奉淼 张海兵 曹美香 夏卫东[1] 李文帅[1] 李庆民 张信芳[1] 张全忠[1] WANG Fengmiao;ZHANG Haibing;CAO Meixiang;XIA Weidong;LI Wenshuai;LI Qingmin;ZHANG Xinfang;ZHANG Quanzhong(Heze Municipal Hospital,Heze 274033,China)

机构地区：[1]菏泽市立医院,山东菏泽274033

出　　处：《中国实用神经疾病杂志》2020年第19期1679-1684,共6页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金(编号:81860450)。

摘　　要：目的探讨体感诱发电位(SSEP)和脑电图(EEG)多模态监测在颈动脉内膜切除术中的应用价值。方法25例症状性颈动脉狭窄病人行标准颈动脉内膜切除手术,术中采用SSEP和EEG多模态监测,当任一监测方法或两种方法均出现显著变化时给予升高血压、尽快完成手术减少阻断时间、滴注依达拉奉、术中转流等措施处理。结果当阻断颈动脉后,监测出现显著变化16例,给予升高血压后13例恢复,2例加快手术进度,滴注依达拉奉,1例采用术中转流。术后24 h内未出现卒中,1例因出现肺部感染、心功能障碍于术后1周死亡,余24例术后1个月mRS评分,0分15例,1分8例,3分1例。分别将SSEP监测和EEG监测、SSEP监测和SSEP+EEG多模态监测、EEG监测和SSEP+EEG多模态监测进行配对资料的χ2检验,其P值分别为0.791、0.008、0.031。结论SSEP和EEG多模态监测优于单一监测,可准确评估颈动脉内膜切除术中脑血流量和氧供,准确判断术中低灌注,以便于及时采取措施恢复灌注,降低围手术期卒中的发生。Objective To describe the application of somatosensory evoked potential(SSEP)and electroencephalogram(EEG)in carotid endarterectomy.Methods 25 patients with symptomatic carotid stenosis underwent standard carotid ndarterectomy.During the operation,SSEP and EEG were used.When either or both of the monitoring methods changed significantly,measures such as increasing hypertension,completing the operation as soon as possible,reducing the blocking time,injecting edaravone,and intraoperative shunting were taken.Results When the carotid artery was cross clamping,16 patients showed significant changes in monitoring.13 cases recovered after ascending the hypertension,in the 3 patients who did not recover,2 patients were treated with accelerated operation,drip of edaravone and 1 patient underwent intraoperative shunting.There was no stroke in 24 hours after operation.One patient died in 1 week after operation due to pulmonary infection and cardiac dysfunction.The other 24 patients had mRS score in 1 month after operation.15 patients had 0 score,8 patients had 1 score,and 1 patient had 3 score.The Chi square test of SSEP monitoring and EEG monitoring,SSEP monitoring and SSEP+EEG multimodal monitoring,EEG monitoring and SSEP+EEG multimodal monitoring were carried out.The P value was 0.791,0.008 and 0.031,respectively.Conclusion The multimodal monitoring of somatosensory evoked potential and electroencephalogram is better than single monitoring.They can accurately evaluate the cerebral blood flow and oxygen supply during carotid endarterectomy,accurately judge the intraoperative low perfusion,so as to take timely measures to restore perfusion and reduce the incidence of perioperative stroke.

关 键 词：颈动脉内膜切除术 颈动脉狭窄 体感诱发电位 脑电图 术中监测 

分 类 号：R543[医药卫生—心血管疾病]