Salvian A J, Taylor D C, Hsiang Y N, Hildebrand H D, Litherland H K, Humer M F, Teal P A, MacDonald D B
Department of Surgery, Vancouver Hospital and the University of British Columbia, Canada.
Cardiovasc Surg. 1997 Oct;5(5):481-5. doi: 10.1016/s0967-2109(97)00044-6.
The purpose of this study was to identify whether EEG is an adequate method of monitoring cerebral perfusion during carotid endarterectomy and of determining the need for use of an indwelling shunt. A retrospective review of 305 carotid endarterectomies comparing the results of routinely shunted patients with patients selectively shunted based on EEG monitoring, was carried out. Of the carotid endarterectomies, 92 (30%) were routinely shunted and 213 (70%) were selectively shunted. In the selectively shunted group, 34 (16%) subsequently required shunting. The major stroke rate in the routinely shunted group was 4.4% ((4) cases) and in the selectively shunted group was 0.5% ((1) stroke). Three of the four major strokes in the routinely shunted group were embolic in origin and one was caused by acute thrombosis. The only major stroke in the selectively shunted group was from intracerebral hemorrhage. In conclusion EEG monitoring is a safe and reliable method to determine the need for shunting during carotid endarterectomy. Routine non-selective use of a shunt may increase the risk of perioperative stroke from arterial injury and associated thromboembolism.
本研究的目的是确定脑电图（EEG）是否是一种在颈动脉内膜切除术期间监测脑灌注以及确定是否需要使用留置分流管的合适方法。对305例颈动脉内膜切除术进行了回顾性研究，比较了常规分流患者与基于EEG监测进行选择性分流患者的结果。在这些颈动脉内膜切除术中，92例（30%）进行了常规分流，213例（70%）进行了选择性分流。在选择性分流组中，34例（16%）随后需要分流。常规分流组的主要卒中发生率为4.4%（4例），选择性分流组为0.5%（1例卒中）。常规分流组的4例主要卒中中，3例源于栓塞，1例由急性血栓形成引起。选择性分流组唯一的主要卒中是由脑出血导致。总之，EEG监测是一种安全可靠的方法，可用于确定颈动脉内膜切除术期间是否需要分流。常规非选择性使用分流管可能会增加因动脉损伤及相关血栓栓塞导致围手术期卒中的风险。
