Cerebral monitoring by means of oximetry and somatosensory evoked potentials during carotid endarterectomy
Cerebral monitoring by means of oximetry and somatosensory evoked potentials during carotid endarterectomy
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DOI：
10.3171/jns.1998.89.4.0533
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发表时间：
1998-10-01
影响因子：
4.1
通讯作者：
Sclabassi, RJ
中科院分区：
文献类型：
--
作者：
Cho, H;Nemoto, EM;Sclabassi, RJ
目的。颈动脉内膜切除术期间发生的脑缺血通常通过体感诱发电位（SSEP）和脑电图（EEG）进行监测。作者进行了这项研究，以确定是否也可以通过脑血氧测定法可靠地检测脑缺血。方法。通过 SSEP、EEG 和使用 NIR0500 型（20 名患者）或 INVOS3100A（9 名患者）血氧计的脑血氧测定法对 29 名接受颈动脉内膜切除术的患者进行监测。 SSEP幅度的变化分级如下：0，无变化； 1、下降幅度小于50%； 2、下降幅度大于50%； 3、减少100%。根据 NIR0500 血氧计测量，关闭颈总动脉使 SSEP 为 1 至 3 组（- 13.11 +/- 5.59 mu M [平均 +/- 标准差]，12 名患者）平均氧合血红蛋白水平降低两倍（p < 0.005），是 SSEP 为 0 组（-6.22 +/- 5.59 mu）的两倍（p < 0.005）。 M，八名患者）。脱氧血红蛋白的升高也更大（p < 0.05）。使用 INVOS3100A 血氧计监测的 9 名患者中，有 2 名的 SSEP 为 1 和 3，他们的区域氧饱和度 (rSO(2)) 值分别下降了 -11.50 和 -11.51。在其余 7 名 SSEP 为 0 的患者中，rSO(2) 范围在 -2.00 至 -6.10 之间，与 SSEP 为 1 至 3 的组没有重叠。在打开颈外动脉后，使用 NIR0500 血氧计监测的氧合血红蛋白增加和使用 INVOS3100A 机器监测的 rSO(2) 增加少于打开颈内动脉后观察到的增加。两种类型的血氧计都可以检测脑缺血，但 NIR0500 会出现假阴性，而 INVOS3100A 则不会出现假阴性。 INVOS3100A 的颅外污染发生率也比 NIR0500 监测仪低四倍。结论。结果表明，至少根据 INVOS3100A 仪器的测量，rSO(2) 降低至 10 或更多或 rSO(2) 降低至 50 以下，表明脑缺血的严重程度足以降低 SSEP 的幅度。
Object. Cerebral ischemia that occurs during carotid endarterectomy is commonly monitored by means of somatosensory evoked potentials (SSEPs) and electroencephalography (EEG). The authors conducted this study to determine whether cerebral ischemia could also be reliably detected by cerebral oximetry.Methods. Twenty-nine patients who underwent carotid endarterectomy were monitored by means of SSEPs, EEG, and cerebral oximetry with a model NIR0500 (20 patients) or INVOS3100A (nine patients) oximeter. Changes in amplitude of SSEPs were graded as follows: 0, no change; 1, decrease of less than 50%; 2, decrease of greater than 50%; and 3, 100% decrease. As measured with the NIR0500 oximeter, closing the common ca ro-tid artery decreased mean oxyhemoglobin levels twice as much (p < 0.005) in the group with SSEPs of 1 to 3 (- 13.11 +/- 5.59 mu M [mean +/- standard deviation], 12 patients) as in the group with SSEPs of 0 (-6.22 +/- 5.59 mu M, eight patients). The rise in deoxyhemoglobin was also greater (p < 0.05). Two of nine patients monitored with the INVOS3100A oximeter had SSEPs of 1 and 3, and their regional saturation of oxygen (rSO(2)) values fell by -11.50 and -11.51, respectively. In the remaining seven patients with SSEPs of 0, the rSO(2) ranged between -2.00 and -6.10 with no overlap with the group with SSEPs of 1 to 3. The increase in oxyhemoglobin monitored using the NIR0500 oximeter and rSO(2) monitored using the INVOS3100A machine after opening the external carotid artery was less than that seen after opening the internal carotid artery. Both types of oximeters could detect cerebral ischemia but whereas false negatives occurred with the NIR0500, none was observed with the INVOS3100A. Extracranial contamination was also four times less frequent with the INVOS3100A than with the NIR0500 monitor.Conclusions. The results indicate that at least as measured with the INVOS3100A instrument, a decrease in rSO(2) of - 10 or more or a decrease below an rSO(2) of 50 is indicative of cerebral ischemia of sufficient severity to decrease the amplitude of SSEPs.