Arom K V, Cohen D E, Strobl F T
Minneapolis Heart Institute, Minnesota.
Ann Thorac Surg. 1989 Oct;48(4):476-83. doi: 10.1016/s0003-4975(10)66843-9.
Neurological complications of cardiopulmonary bypass procedures are well documented. The present two-part study was undertaken to (1) determine if on-line computerized electroencephalographic changes correlated with neurological outcome and (2) compare neurological outcome with that of a second group of patients who received intraoperative interventions based on electroencephalographic data. Part 1 consisted of monitoring 50 patients. A power drop index was developed that correlated with new global neurological deficits. New global deficits occurred in 44% of the patients. In part 2, this information was used to design intervention criteria. Treatment protocols used previously accepted methods of increasing cerebral blood flow, ie, increasing pump flow, raising mean arterial pressure, and increasing CO2 content in the ventilator blend. Global neurological deficits were reduced to 5% in a group of 41 clinically similar patients (p less than 0.001). Cerebral perfusion pressures were similar in both groups. The single correlating factor was the power drop index as identified by computerized EEG. Our conclusion is that simple intervention guided by computerized EEG can reduce global neurological deficits in patients having cardiopulmonary bypass procedures.
心肺转流手术的神经并发症已有充分记录。目前的这项分为两部分的研究旨在：（1）确定在线计算机化脑电图变化是否与神经功能结局相关；（2）将神经功能结局与另一组基于脑电图数据进行术中干预的患者进行比较。第一部分包括对50名患者的监测。开发了一种与新出现的整体神经功能缺损相关的功率下降指数。44%的患者出现了新的整体缺损。在第二部分中，这些信息被用于设计干预标准。治疗方案采用了先前公认的增加脑血流量的方法，即增加泵流量、提高平均动脉压以及增加呼吸机混合气中的二氧化碳含量。在一组41名临床情况相似的患者中，整体神经功能缺损降至5%（p<0.001）。两组的脑灌注压相似。唯一的相关因素是计算机化脑电图确定的功率下降指数。我们的结论是，由计算机化脑电图指导的简单干预可减少接受心肺转流手术患者的整体神经功能缺损。
