脑电图联合局部脑氧饱和度监测脑灌注在颈动脉内膜剥脱术中的应用  

Electroencephalogram combined with regional oxygen saturation in monitoring cerebral perfusion during carotid endarterectomy

作　　者：顾大群 张扬[1] 晁迎九 陈昱[1] 高歌 余舰 夏成雨 刘向 牛朝诗 傅先明 Gu Daqun;Zhang Yang;Chao Yingjiu;Chen Yu;Gao Ge;Yu Jian;Xia Chengyu;Liu Xiang;Niu Chaoshi;Fu Xianming(Department of Neurosurgery,First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Anhui Province Key Laboratory of Brain Function and Brain Disease,Anhui Provincial Stereotactic Neurosurgical Institute,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)神经外科,脑功能与脑疾病安徽省重点实验室,安徽省脑立体定向神经外科研究所,合肥230001

出　　处：《中华神经医学杂志》2021年第4期346-349,共4页Chinese Journal of Neuromedicine

基　　金：安徽省2018年度重点研究与开发计划(1804h08020250)。

摘　　要：目的探讨脑电图(EEG)联合局部脑氧饱和度(rSO2)监测脑灌注在颈动脉内膜剥脱术(CEA)中的应用价值。方法选择中国科学技术大学附属第一医院(安徽省立医院)神经外科自2018年1月至2019年12月行CEA术治疗42例动脉粥样硬化性颈动脉狭窄患者进行研究,所有患者手术均在EEG联合rSO2监测下进行。回顾性分析患者的临床资料,探讨EEG联合rSO2监测CEA术中患者脑灌注异常的有效性和安全性。结果术中颈动脉阻断后,42例患者中EEG及rSO2监测正常24例,EEG监测仅出现异常2例,rSO2监测仅出现异常3例,EEG及rSO2联合监测出现异常13例。EEG和(或)rSO2监测出现异常的18例患者中,17例予升高血压后恢复,1例使用转流管后恢复。单独EEG和单独rSO2监测显示脑灌注异常的一致性较好(Kappa=0.745,P=0.000);2种方法联合监测、单独EEG、单独rSO2监测的阳性率分别为42.9%、35.7%、38.1%。出院前所有患者均未发现新的脑部缺血灶和临床症状。结论EEG、rSO2监测CEA术中脑灌注异常具有较好的一致性,二者联合应用可弥补单一监测的不足,增加手术的安全性。Objective To investigate the application value of electroencephalogram(EEG)combined with regional cerebral oxygen saturation(rSO2)in monitoring cerebral perfusion during carotid endarterectomy(CEA).Methods A retrospective analysis of clinical data of 42 patients with atherosclerotic carotid artery stenosis admitted to and accepted CEA in our hospital from January 2018 to December 2019 was performed.CEA was performed under EEG combined with rSO2 monitoring.The efficacy and safety of EEG combined with rSO2 in monitoring cerebral perfusion abnormalities during CEA were analyzed.Results After carotid artery occlusion,24 patients(57.1%)had normal EEG and rSO2;15(35.7%)had abnormal changes of EEG,among whom 13(31.0%)were accompanied by rSO2 anomaly;16(38.1%)had abnormal rSO2,among whom 13(31.0%)were accompanied by EEG anomaly.Of these 18 patients with abnormal EEG and/or rSO2 monitoring,17 patients recovered after increasing their blood pressure and 1 patient recovered after diverter tube usage.Intraoperative EEG and rSO2 monitoring results were consistent(Kappa=0.745,P=0.000).The positive rates of combined monitoring,EEG alone or rSO2 alone were 42.9%,35.7%and 38.1%,respectively.All patients were evaluated clinically and radiologically before discharge,and no new ischemic lesions or clinical symptoms were found.Conclusions EEG and rSO2 monitoring are well consistent in CEA;the combined monitoring can make up for the deficiency of single monitoring to increase surgical safety.

关 键 词：颈动脉狭窄 颈动脉内膜剥脱术 脑电图 局部脑氧饱和度 脑灌注 

分 类 号：R651.12[医药卫生—外科学]