Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University.
Department of Electrophysiology, Beijing Neurosurgical Institute, Beijing, People's Republic of China.
J Neurosurg Anesthesiol. 2022 Jan 1;34(1):29-34. doi: 10.1097/ANA.0000000000000690.
The aim of this study was to assess the diagnostic ability of near-infrared spectroscopy-monitored regional cerebral oxygen saturation (rSO2) to detect cerebral hypoperfusion during internal carotid artery (ICA) clamping compared with motor and somatosensory evoked potential (EP) monitoring.
This prospective study recruited consecutive patients undergoing carotid endarterectomy under general anesthesia. Significant EP changes (defined as >50% decrease in ipsilateral somatosensory EP amplitude or disappearance of contralateral motor EP on >2 consecutive stimulations) during ICA clamping were considered a warning sign for cerebral hypoperfusion. If significant EP changes occurred, the amplitude of the EPs and simultaneous rSO2 values were recorded before therapeutic intervention. The relationship between reductions in rSO2 and EP amplitudes was analyzed using Spearman rank-correlation analysis. Receiver operating characteristic curve analysis was used to calculate the optimal cutoff value for the relative reduction in rSO2. False-positive rates were evaluated according to immediate postoperative motor outcomes.
A total of 203 patients were included for analysis, of whom 23 developed significant EP changes during ICA clamping. There was a positive relationship between decreases in EP amplitude and rSO2 (R2=0.15, P=0.02). A rSO2 reduction ≥16% from baseline had the optimal diagnostic performance for the detection of cerebral hypoperfusion (area under the receiver operating characteristic curve=0.82; 95% confidence interval: 0.76-0.87). The false-positive rate was 8.9%.
Decreases in rSO2 correlated with decreases in EP amplitude during ICA clamping. A relative reduction in rSO2 ≥16% could serve as a warning for clamping-associated cerebral hypoperfusion. The 8.9% false-positive rate is a potential clinical limitation of the use of rSO2 to predict postoperative neurological deficits.
本研究旨在评估近红外光谱监测局部脑氧饱和度（rSO2）与运动和体感诱发电位（EP）监测相比，在检测颈内动脉（ICA）夹闭期间脑灌注不足方面的诊断能力。
本前瞻性研究招募了 203 例在全身麻醉下接受颈动脉内膜切除术的连续患者。ICA 夹闭期间发生的 EP 显著变化（定义为同侧体感 EP 幅度下降>50%或对侧运动 EP 消失>2 次连续刺激）被认为是脑灌注不足的预警信号。如果发生显著的 EP 变化，则在进行治疗干预之前记录 EP 的振幅和同时的 rSO2 值。使用 Spearman 等级相关分析分析 rSO2 减少与 EP 振幅之间的关系。使用受试者工作特征曲线分析计算 rSO2 相对减少的最佳截断值。根据术后即刻运动结果评估假阳性率。
共有 203 例患者纳入分析，其中 23 例在 ICA 夹闭期间发生了显著的 EP 变化。EP 幅度的降低与 rSO2 呈正相关（R2=0.15，P=0.02）。rSO2 从基线降低≥16%对检测脑灌注不足具有最佳诊断性能（受试者工作特征曲线下面积=0.82；95%置信区间：0.76-0.87）。假阳性率为 8.9%。
ICA 夹闭期间 rSO2 的降低与 EP 振幅的降低相关。rSO2 相对降低≥16%可作为与夹闭相关的脑灌注不足的预警。8.9%的假阳性率是使用 rSO2 预测术后神经功能缺损的潜在临床限制。
