Burst suppression or isoelectric encephalogram for cerebral protection: evidence from metabolic suppression studies
Burst suppression or isoelectric encephalogram for cerebral protection: evidence from metabolic suppression studies
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DOI：
10.1093/bja/83.4.580
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发表时间：
1999-10-01
影响因子：
9.8
通讯作者：
Matta, BF
中科院分区：
文献类型：
--
作者：
Doyle, PW;Matta, BF
代谢抑制可能具有脑保护作用。通常认为，定性爆发抑制的脑代谢和保护作用与等电脑电图（EEG）相似。我们研究了不同程度的脑电抑制对全身麻醉期间血流量和氧差的影响。我们研究了11例接受全身麻醉切除听神经瘤的患者。研究在手术后用丙泊酚和瑞芬太尼麻醉进行。经颅多普勒超声检查和颈静脉球静脉饱和度测量值的脑电图抑制：0%，50%和100%（等电脑电图）。9例患者的数据适合分析。平均动脉压、心率、起搏、脑电图活动、50%爆发抑制率、等电位脑电图均无显著差异。随着EEG抑制程度的增加，大脑中动脉血流速度（VMCA）显著降低（0%抑制，平均38（SEM 4）cm s（-1）; 50%抑制，平均29（3）cm s（-1）; 100%抑制，平均24（2）cm s（-1）; P < 0.05）。颈静脉球静脉饱和度的变化并不一致的EEG活动的变化，表明完整的流量代谢耦合。我们的结论是脑电图抑制的程度对血流有显着的影响。如果血流-代谢耦合得以维持，则50% EEG爆发抑制期间的脑代谢等同于等电EEG的假设可能不合理。如果脑保护与脑代谢有关，那么等电EEG可能比50%爆发抑制提供更多的脑保护。
Metabolic suppression may have a role in cerebral protection. It is often assumed that the cerebral metabolic and protective effects of qualitative burst suppression are similar to those of the isoelectric encephalogram (EEG). We have examined the effect of different degrees of EEG suppression on blood flow and oxygen difference during general anaesthesia. We studied I I patients undergoing general anaesthesia for resection of acoustic neuromas. The study was performed after surgery with propofol and remifentanil anaesthesia. Transcranial Doppler ultrasonography and jugular bulb venous saturations were measured at values of EEG suppression: 0%, 50% and 100% (isoelectric EEG). Data from nine patients were suitable for analysis. There were no significant differences in mean arterial pressure, heart rate or Pace, during EEG activity, 50% burst suppression ratio or isoelectric EEG. There was a significant decrease in middle cerebral artery flow velocity (vmca) with increasing EEG suppression (0% suppression, mean 38 (SEM 4) cm s(-1); 50% suppression, 29 (3) cm s(-1); and 100% suppression, 24 (2) cm s(-1); P < 0.05). Jugular bulb venous saturations did not change consistently with the change in EEG activity, indicating intact flow-metabolism coupling. We conclude that the degree of EEG suppression had a significant effect on blood flow. If flow-metabolism coupling is maintained, the assumption that cerebral metabolism during 50% EEG burst suppression is equivalent to isoelectric EEG may not be justified. If cerebral protection is related to brain metabolism, then an isoelectric EEG may give more cerebral protection than 50% burst suppression.