Pugliese Francesco, Ruberto Franco, Tosi Antonella, Martelli Sabina, Bruno Katia, Summonti Deborah, D'Alio Alessandra, Diana Beatrice, Anile Marco, Panico Antonietta, Speziale Francesco, Pietropaoli Paolo
Dipartimento Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Italy.
Eur J Anaesthesiol. 2009 Aug;26(8):643-7. doi: 10.1097/EJA.0b013e32832b89c2.
The aim of this study was to compare a cerebral oximeter with transcranial Doppler (TCD) as a neurological monitor in patients undergoing carotid endarterectomy under regional anaesthesia.
Forty patients were enrolled for this prospective study. We recorded every adverse neurological event after arterial clamping and variations in parameters evaluated by the two monitoring systems in order to determine whether there was any correlation between TCD data and those obtained by regional cerebral saturation, the timing of detection of the adverse event in both clinical examination and instrumental data and the presence of any false positives or negatives in any of the two monitoring systems.
Shunting was necessary in eight patients, following clinical signs of a neurological deficit during clamping. In these patients, a significant reduction in TCD values and regional cerebral saturation values from baseline was recorded. We observed a drastic reduction in TCD values in four patients during clamping (6 +/- 5 versus 41 +/- 4 cm s) that was not associated with any neurological deficit or reduction in regional cerebral saturation values (51 +/- 4 versus 54 +/- 7%). Instrumental detection of a neurological deficit anticipated the clinical observation of about 5-10 s.
We observed a greater reliability with the cerebral oximeter than with TCD in our patients.
本研究旨在比较在区域麻醉下行颈动脉内膜切除术的患者中，脑血氧饱和度仪与经颅多普勒（TCD）作为神经监测手段的效果。
40例患者纳入本前瞻性研究。我们记录了动脉夹闭后每例不良神经事件以及两种监测系统所评估参数的变化，以确定TCD数据与局部脑饱和度所获数据之间是否存在相关性、临床检查和仪器数据中不良事件的检测时机，以及两种监测系统中是否存在假阳性或假阴性。
8例患者在夹闭期间出现神经功能缺损临床体征后需要分流。在这些患者中，记录到TCD值和局部脑饱和度值较基线显著降低。我们观察到4例患者在夹闭期间TCD值急剧降低（6±5对41±4 cm/s），但未伴有任何神经功能缺损或局部脑饱和度值降低（51±4对54±7%）。仪器检测到的神经功能缺损比临床观察提前约5 - 10秒。
在我们的患者中，我们观察到脑血氧饱和度仪比TCD具有更高的可靠性。
