Liu Hong, Di Giorgio Anthony M, Williams Eric S, Evans William, Russell Michael J
Department of Anesthesiology University of California, Davis Medical Center, Sacramento, CA 95817, USA.
J Biomed Res. 2010 Nov;24(6):460-6. doi: 10.1016/S1674-8301(10)60061-9.
Near zero stroke rates can be achieved in carotid endarterectomy (CEA) surgery with selective shunting and electrophysiological neuromonitoring. though false negative rates as high as 40% have been reported. We sought to determine if improved training for interpretation of the monitoring signals can advance the efficacy of selective shunting with electrophysiological monitoring across multiple centers, and determine if other factors could contribute to the differences in reports. Processed and raw beta band (12.5-30 Hz) electroencephalogram (EEG) and median and tibial nerve somatosensory evoked potentials (SSEP) were monitored in 668 CEA cases at six surgical centers. A decrease in amplitude of 50% or more in any EEG or SSEP channel was the criteria for shunting or initiating a neuroprotective protocol. A reduction of 50% or greater in the beta band of the EEG or amplitude of the SSEP was observed in 150 cases. No patient showed signs of a cerebral infarct after surgery. Selective shunting based on EEG and SSEP monitoring can reduce CEA intraoperative stroke rate to a near zero level if trained personnel adopted standardized protocols. We also found that the rapid administration of a protective stroke protocol by attending anesthesiologists was an important aspect of this success rate.
通过选择性分流和电生理神经监测，颈动脉内膜切除术（CEA）手术的中风率可接近零，尽管有报道称假阴性率高达40%。我们试图确定，改进监测信号解读培训是否能提高多中心电生理监测下选择性分流的疗效，并确定是否有其他因素导致报告结果存在差异。在六个手术中心的668例CEA病例中，监测了处理后的和原始的β波段（12.5 - 30Hz）脑电图（EEG）以及正中神经和胫神经体感诱发电位（SSEP）。任何EEG或SSEP通道的幅度下降50%或更多是进行分流或启动神经保护方案的标准。150例患者出现EEG的β波段或SSEP幅度下降50%或更多。术后无患者出现脑梗死迹象。如果训练有素的人员采用标准化方案，基于EEG和SSEP监测的选择性分流可将CEA术中中风率降至接近零的水平。我们还发现，主治麻醉医生快速实施保护性中风方案是成功率的一个重要因素。
