The Efficacy of Near-Infrared Spectroscopy Monitoring in Carotid Endarterectomy: A Prospective, Single-Center, Observational Study
The Efficacy of Near-Infrared Spectroscopy Monitoring in Carotid Endarterectomy: A Prospective, Single-Center, Observational Study
复制标题
近红外光谱监测在颈动脉内膜切除术中的疗效：一项前瞻性、单中心、观察性研究
DOI：
10.1177/0963689718817760
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发表时间：
2019-02-01
影响因子：
3.3
通讯作者：
Feng, Kunpeng
中科院分区：
文献类型：
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作者：
Wang, Yu;Li, Li;Feng, Kunpeng
到目前为止，颈动脉内膜剥脱术(CEA)的术中监护尚无金标准。本研究的目的是探讨近红外光谱(NIRS)监测在CEA中的应用价值，并探讨术中脑低灌注的阈值。选择首都医科大学宣武医院2015年8月至2016年6月连续84例CEA手术患者为研究对象。术中应用经颅多普勒超声(TCD)和近红外光谱(NIRS)进行监测。连续记录NIRS监测的局部血氧饱和度(RSO2)和经颅多普勒(TCD)监测的大脑中动脉血流速度(V-MCA)。对NIRS和TCD监测值进行相关分析。5例术中根据TCD监测结果和外科医生喜好行术中分流。阻断颈动脉时，rSO_2与V-MCA的Pearson相关系数为0.581(P<；0.001)。以rSO2值下降12.3%作为术中低灌注度的临界值，其敏感性和特异性分别为64.3%和90.0%，Kappa值为0.570。术后即刻体格检查无一例发生缺血性损伤，术后住院期间无死亡及中风发生。我们的研究表明，近红外光谱可以作为CEA中的一种有利的监测工具。RSO2下降12.3%可作为术中脑低灌注的可靠阈值。
There has been no gold standard for intraoperative monitoring in carotid endarterectomy (CEA) till now. The purpose of the current study was to investigate the value of near-infrared spectroscopy (NIRS) monitoring in CEA and explore the thresholds for intraoperative cerebral hypoperfusion. Eighty-four consecutive patients who underwent CEA surgery in Xuan Wu Hospital of Capital Medical University from August 2015 to June 2016 were enrolled in this study. All patients were intraoperatively monitored by transcranial Doppler ultrasonography (TCD) and NIRS. Regional oxygen saturation (rSO2) monitored by NIRS and blood flow velocity of the middle cerebral artery (V-MCA) monitored by TCD were continuously recorded. Correlation analysis was conducted for NIRS and TCD monitoring values. Intraoperative shunting was performed in five patients according to the TCD monitoring results and surgeon preference. During clamping of the carotid artery, the Pearson correlation index between rSO2 and V-MCA was 0.581 (P<0.001). A cut-off of 12.3% decrease of rSO2 was identified as the optimal threshold for intraoperative hypoperfusion indicated by TCD monitoring, when the sensitivity and specificity were 64.3% and 90.0%, respectively, with a 0.570 Kappa value. Physical examination immediately after operation showed no ischemic injury occurred, and no death and stroke occurred during the postoperative hospitalization. Our study demonstrated that NIRS could serve as a favorable monitoring tool during CEA. A 12.3% decrease of rSO2 could be adopted as a reliable threshold for intraoperative cerebral hypoperfusion.