Saidi Nousheh, Murkin John M
Department of Anesthesiology and Perioperative Medicine (Clinical Fellow), University of Western Ontario, London, Ontario.
Semin Cardiothorac Vasc Anesth. 2005 Mar;9(1):17-23. doi: 10.1177/108925320500900103.
Various studies have demonstrated that over 50% of patients presenting for coronary revascularization surgery have evidence of extracranial or intracranial atherosclerotic disease. Although evidence is compelling that cerebral emboli are a major cause of perioperative central nervous system (CNS) morbidity in such patients, it is also apparent that alterations in cerebral perfusion pressure and blood flow can profoundly influence the extent of injury after an embolic insult. In this context, the recent studies demonstrating improved CNS outcomes with applied neuromonitoring in cardiac surgical patients can be understood as reflecting the optimization of CNS perfusion characteristics with potential amelioration of microembolic injury. This review critically evaluates and discusses the relevant characteristics of applied neuromonitoring techniques, including bispectral index (BIS), transcranial Doppler (TCD), and near infrared reflectance spectroscopy (NIRS) in the context of patients undergoing cardiac surgical procedures. Recent outcomes data regarding CNS and related morbidity and the influence of neuromonitoring in these groups are evaluated.
多项研究表明，接受冠状动脉血运重建手术的患者中，超过50%有颅外或颅内动脉粥样硬化疾病的证据。尽管有令人信服的证据表明脑栓塞是这类患者围手术期中枢神经系统（CNS）发病的主要原因，但很明显，脑灌注压和血流的改变会深刻影响栓塞损伤后的损伤程度。在这种情况下，最近的研究表明，在心脏手术患者中应用神经监测可改善CNS结局，这可以理解为反映了CNS灌注特征的优化以及对微栓塞损伤的潜在改善。这篇综述批判性地评估和讨论了在心脏手术患者中应用的神经监测技术的相关特征，包括脑电双频指数（BIS）、经颅多普勒（TCD）和近红外光谱（NIRS）。评估了这些组中关于CNS及相关发病率的近期结局数据以及神经监测的影响。
