Illig Karl A, Sternbach Yaron, Zhang Renyu, Burchfiel James, Shortell Cynthia K, Rhodes Jeffrey M, Davies Mark G, Lyden Sean P, Green Richard M
Division of Vascular Surgery, University of Rochester Medical Center, NY 14642, USA.
Ann Vasc Surg. 2002 Jan;16(1):6-11. doi: 10.1007/s10016-001-0135-3. Epub 2002 Jan 16.
To determine the reason for differing shunt rates based on electroencephalographic (EEG) and neurologic changes during general and regional anesthetic, respectively, we compared simultaneous EEG tracings and neurologic status in 135 patients undergoing carotid endarterectomy (CEA) under cervical block over a 30-month period. The decision to shunt in these patients was made on the basis of neurologic changes only irrespective of EEG findings. This group was then compared to the 288 patients undergoing CEA under general anesthetic with EEG monitoring over the same period. EEG changes occurred in 7.4% of awake patients and 15.3% of asleep patients (p < 0.03). The rates of ipsilateral hemispheric changes were similar, but no awake patient manifested global EEG changes with clamping while 3.5% of patients under general anesthesia did (p < 0.04). Global, but not hemispheric, changes were correlated with systolic blood pressure variability during clamping. This implies that global EEG changes in anesthetized patients may be the result of the anesthetic technique itself, and that cervical block may in fact be cerebroprotective.
为了分别确定在全身麻醉和区域麻醉期间基于脑电图（EEG）和神经学变化的分流率差异的原因，我们在30个月的时间里比较了135例接受颈丛阻滞下行颈动脉内膜切除术（CEA）患者的同步EEG描记图和神经学状态。这些患者的分流决定仅基于神经学变化，而不考虑EEG结果。然后将该组患者与同期288例接受全身麻醉并进行EEG监测的CEA患者进行比较。EEG变化发生在7.4%的清醒患者和15.3%的睡眠患者中（p<0.03）。同侧半球变化的发生率相似，但没有清醒患者在夹闭时出现全脑EEG变化，而全身麻醉下有3.5%的患者出现（p<0.04）。全脑而非半球变化与夹闭期间的收缩压变异性相关。这意味着麻醉患者的全脑EEG变化可能是麻醉技术本身的结果，并且颈丛阻滞实际上可能具有脑保护作用。
