Mracek J, Holecková I, Mork J, Frdlík J, Skorpil J
Neurochirurgické oddĕlení LF UK a FN Plzen.
Rozhl Chir. 2009 May;88(5):264-8.
To demonstrate the benefit of peroperative electrophysiological monitoring and neuroprotection in cardiac surgery that makes use a cardiopulmonary bypass in patients with a high risk of stroke and to analyze the importance of prophylactic carotid endarterectomy.
Cerebral ischemia is the most dreaded complication of cardiovascular operations that make use of a cardiopulmonary bypass. It is necessary to select an approach that minimalizes neurological complications. In our treatment strategy we use preoperative electrophysiological monitoring and neuroprotection. Prophylactic carotid endarterectomy performed as part of a combined operation we performed in patients with a high risk of hemodynamic stroke.
We retrospectively evaluated 86 patients (2004-2008) after cardiac surgery that made use of a cardiopulmonary bypass and synchronous electrophysiological neuromonitoring. After any decrease in neuronal function neuroprotection was used. Combined carotid and cardiac operations were performed under one general anestesia in ten patients with a high risk of hemodynamic stroke.
A peroperative decline in electrophysiological responses was noted in 76.5%, of these 54.5% were insignificant alterations, 42.4% significant and in two cases there was a total deletion. After administration of neuroprotection electrophysiological responses partially normalized in 14%, totally normalized in 60% and did not change in 26%. Only one permanent stroke and four temporary encephalopathy were identified after surgery. No morbidity/mortality were detected after combined operations.
Peroperative electrophysiological neuromonitoring combined with neuroprotection eliminate cerebral ischemic complications in cardiac surgery that makes use of a cardiopulmonary bypass. Selected patients with high risk of hemodynamic stroke profit from carotid endarterectomy.
证明在有高卒中风险患者的心脏手术中，术中电生理监测和神经保护的益处，并分析预防性颈动脉内膜切除术的重要性。
脑缺血是使用体外循环的心血管手术中最可怕的并发症。选择一种能将神经并发症降至最低的方法很有必要。在我们的治疗策略中，我们使用术前电生理监测和神经保护。作为联合手术的一部分，我们对有血流动力学性卒中高风险的患者进行预防性颈动脉内膜切除术。
我们回顾性评估了86例（2004 - 2008年）接受体外循环心脏手术及同步电生理神经监测的患者。在神经元功能出现任何下降后，使用神经保护措施。10例有血流动力学性卒中高风险的患者在一次全身麻醉下进行了颈动脉和心脏联合手术。
76.5%的患者术中电生理反应下降，其中54.5%为轻微改变，42.4%为显著改变，2例完全消失。给予神经保护后，14%的患者电生理反应部分恢复正常，60%完全恢复正常，26%无变化。术后仅发现1例永久性卒中及4例短暂性脑病。联合手术后未检测到 morbidity/mortality 。
术中电生理神经监测联合神经保护可消除使用体外循环的心脏手术中的脑缺血并发症。选定的有血流动力学性卒中高风险的患者可从颈动脉内膜切除术中获益。
