神经功能缺损患者在清醒颈动脉内膜切除术期间的脑电双频指数变化。

Bispectral index variations in patients with neurological deficits during awake carotid endarterectomy.

机构信息

Anesthesiology and Critical Care Department, Dr Peset University Hospital, and Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain.

出版信息

Eur J Anaesthesiol. 2010 Apr;27(4):359-63. doi: 10.1097/EJA.0b013e32833618ca.

DOI:10.1097/EJA.0b013e32833618ca

PMID:20035229

Abstract

BACKGROUND AND OBJECTIVE

The bispectral index (BIS) is derived from the EEG and therefore may be useful to diagnose intraoperative cerebral ischaemia. This study was undertaken to investigate BIS changes in awake patients with and without neurological deficits during carotid endarterectomy under regional anaesthesia.

METHODS

Seventy consecutive carotid endarterectomies under regional anaesthesia were divided into two surgical groups: patients with and patients without neurological deficits. Patients' neurological status was evaluated and neurological deficits were compared with BIS values. Measurements were made at different surgical stages: baseline, after sedation, at the beginning of surgery, at preclamping, at the 3 min clamping test, during shunt insertion, at declamping, 15 min after declamping and at the end of surgery. We performed intergroup and intragroup comparisons of BIS values. A decrease in BIS of at least 10 associated with neurological deficits was taken as the cut-off point for the classification of patients with logistic regression models (crude and adjusted for potential confounders).

RESULTS

Thirteen patients (18.6% of the total) developed clinical cerebral ischaemia, though BIS values decreased in 10 of these patients (76.9%). The mean BIS values were 92.5+/-5.6 and 84.7+/-12.3 for patients without and with neurological deficits, respectively (P value<0.05). The odds ratios of a BIS decrease associated with neurological deficits were 8.5 (95% confidence interval 2.1-35.1) and 5.4 (95% confidence interval 1.2-24.3) adjusted for contralateral stenosis.

CONCLUSION

Our results describe a relationship between BIS reductions and neurological deficits during carotid surgery in awake patients.

摘要

背景与目的

双频谱指数（BIS）源自脑电图，因此可能有助于诊断术中脑缺血。本研究旨在调查局部麻醉下进行颈动脉内膜切除术时伴有和不伴有神经功能缺损的清醒患者的 BIS 变化。

方法

70 例连续接受局部麻醉下颈动脉内膜切除术的患者分为两组：有神经功能缺损的患者和无神经功能缺损的患者。评估患者的神经状态，并将神经功能缺损与 BIS 值进行比较。测量在不同的手术阶段进行：基础值、镇静后、手术开始时、预夹闭时、3 分钟夹闭试验时、分流器插入时、夹闭时、夹闭后 15 分钟和手术结束时。我们对 BIS 值进行了组间和组内比较。采用逻辑回归模型（未校正和校正潜在混杂因素），将 BIS 值下降至少 10 与神经功能缺损相关作为分类患者的截断值。

结果

13 例（占总数的 18.6%）患者发生临床脑缺血，尽管其中 10 例（76.9%）患者的 BIS 值下降。无神经功能缺损的患者的平均 BIS 值为 92.5±5.6，有神经功能缺损的患者为 84.7±12.3（P 值<0.05）。调整对侧狭窄后，BIS 下降与神经功能缺损相关的比值比为 8.5（95%置信区间 2.1-35.1）和 5.4（95%置信区间 1.2-24.3）。