中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2012年
9期
1111-1114
,共4页
惠晶%崔伟华%刘莉%王明然%乔慧%张东%王硕%韩如泉
惠晶%崔偉華%劉莉%王明然%喬慧%張東%王碩%韓如泉
혜정%최위화%류리%왕명연%교혜%장동%왕석%한여천
颈静脉球%血氧测定法%诱发电位,躯体感觉%诱发电位,运动%监测,手术中%脑缺血
頸靜脈毬%血氧測定法%誘髮電位,軀體感覺%誘髮電位,運動%鑑測,手術中%腦缺血
경정맥구%혈양측정법%유발전위,구체감각%유발전위,운동%감측,수술중%뇌결혈
Glomus jugulare%Oximetry%Evoked potentials,somatosensory%Evoked potentials,motor%Monitoring,intraoperative%Brain ischemia
目的 比较颈静脉血氧饱和度(SjvO2)、体感诱发电位(SSEPs)和运动诱发电位(MEPs)评估颅内动脉瘤夹闭术患者脑缺血发生的准确性.方法 拟行颅内动脉瘤夹闭术患者43例,性别不限,年龄18～64岁,BMI 20 ～ 25 kg/m2,ASA分级Ⅰ或Ⅱ级.气管插管后机械通气,采用丙泊酚-瑞芬太尼全凭静脉麻醉,分别于记录动脉瘤夹闭或载瘤动脉临时阻断前、动脉瘤夹闭或载瘤动脉临时阻断后1、3、10、20、30 min时采集颈内球部血样,测定SjvO2,并于上述时点记录SSEPs和MEPs的波幅及潜伏期,分别记录3种指标判断术中脑缺血发生情况,记录术后3d内神经缺损情况,以发生神经缺损作为判断术中脑缺血发生的金标准.结果 术中发生脑缺血14例.SjvO2评估术中脑缺血发生的灵敏度和特异度分别为71％和93％(P＜0.01);SSEPs评估术中脑缺血发生的灵敏度和特异度分别为71％和62％(P＜ 0.05);以MEPs波幅降低或潜伏期延长作为判断脑缺血发生标准时,评估术中脑缺血发生的灵敏度和特异度分别为79％和52％(P＞ 0.05),以MEPs波幅消失作为判断脑缺血发生标准时,评估术中脑缺血发生的灵敏度和特异度分别为57％和93％(P＜0.05).结论 SjvO2和SSEPs评估颅内动脉瘤夹闭术患者脑缺血发生的灵敏度较高,而SjvO2和MEPs评估脑缺血发生的特异度较高,提示SjvO2是评估脑缺血发生的可靠指标.
目的 比較頸靜脈血氧飽和度(SjvO2)、體感誘髮電位(SSEPs)和運動誘髮電位(MEPs)評估顱內動脈瘤夾閉術患者腦缺血髮生的準確性.方法 擬行顱內動脈瘤夾閉術患者43例,性彆不限,年齡18～64歲,BMI 20 ～ 25 kg/m2,ASA分級Ⅰ或Ⅱ級.氣管插管後機械通氣,採用丙泊酚-瑞芬太尼全憑靜脈痳醉,分彆于記錄動脈瘤夾閉或載瘤動脈臨時阻斷前、動脈瘤夾閉或載瘤動脈臨時阻斷後1、3、10、20、30 min時採集頸內毬部血樣,測定SjvO2,併于上述時點記錄SSEPs和MEPs的波幅及潛伏期,分彆記錄3種指標判斷術中腦缺血髮生情況,記錄術後3d內神經缺損情況,以髮生神經缺損作為判斷術中腦缺血髮生的金標準.結果 術中髮生腦缺血14例.SjvO2評估術中腦缺血髮生的靈敏度和特異度分彆為71％和93％(P＜0.01);SSEPs評估術中腦缺血髮生的靈敏度和特異度分彆為71％和62％(P＜ 0.05);以MEPs波幅降低或潛伏期延長作為判斷腦缺血髮生標準時,評估術中腦缺血髮生的靈敏度和特異度分彆為79％和52％(P＞ 0.05),以MEPs波幅消失作為判斷腦缺血髮生標準時,評估術中腦缺血髮生的靈敏度和特異度分彆為57％和93％(P＜0.05).結論 SjvO2和SSEPs評估顱內動脈瘤夾閉術患者腦缺血髮生的靈敏度較高,而SjvO2和MEPs評估腦缺血髮生的特異度較高,提示SjvO2是評估腦缺血髮生的可靠指標.
목적 비교경정맥혈양포화도(SjvO2)、체감유발전위(SSEPs)화운동유발전위(MEPs)평고로내동맥류협폐술환자뇌결혈발생적준학성.방법 의행로내동맥류협폐술환자43례,성별불한,년령18～64세,BMI 20 ～ 25 kg/m2,ASA분급Ⅰ혹Ⅱ급.기관삽관후궤계통기,채용병박분-서분태니전빙정맥마취,분별우기록동맥류협폐혹재류동맥림시조단전、동맥류협폐혹재류동맥림시조단후1、3、10、20、30 min시채집경내구부혈양,측정SjvO2,병우상술시점기록SSEPs화MEPs적파폭급잠복기,분별기록3충지표판단술중뇌결혈발생정황,기록술후3d내신경결손정황,이발생신경결손작위판단술중뇌결혈발생적금표준.결과 술중발생뇌결혈14례.SjvO2평고술중뇌결혈발생적령민도화특이도분별위71％화93％(P＜0.01);SSEPs평고술중뇌결혈발생적령민도화특이도분별위71％화62％(P＜ 0.05);이MEPs파폭강저혹잠복기연장작위판단뇌결혈발생표준시,평고술중뇌결혈발생적령민도화특이도분별위79％화52％(P＞ 0.05),이MEPs파폭소실작위판단뇌결혈발생표준시,평고술중뇌결혈발생적령민도화특이도분별위57％화93％(P＜0.05).결론 SjvO2화SSEPs평고로내동맥류협폐술환자뇌결혈발생적령민도교고,이SjvO2화MEPs평고뇌결혈발생적특이도교고,제시SjvO2시평고뇌결혈발생적가고지표.
Objective To compare the accuracy of jugular venous oxygen saturation (SjvO2),somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) in estimation of the occurrence of intraoperative cerebral ischemia in patients undergoing clipping of intracranial aneurysm.Methods Forty-three ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with a body mass index of 20-25 kg/m2,undergoing clipping of intracranial aneurysm,were studied.Anesthesia was induced with sufentanil,rocuronium and propofol.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with remifentanil and propofol.Blood samples were taken from the jugular bulb for detection of SjvO2 before aneurysm clipping or temporary occlusion of parent artery and at 1,3,10,20 and 30 min after clipping aneurysm or temporary occlusion of parent artery.The amplitude and latency of SSEPs and MEPs were recorded simultaneously.The occurrence of cerebral ischemia estimated by SjvO2,SSEPs and MEPs was recorded.The condition of nerve defect was recorded within 3 days after operation and the gold standard of cerebral ischemia was defined as the occurrence of nerve defect.Results Among 43 patients,14 cases were diagnosed as having brain ischemia.The sensitivity and specificity of SjvO2 in estimation of the occurrence of intraoperative brain ischemia were 71％ and 93％,respectively (P ＜ 0.01).The sensitivity and specificity of SSEPs in estimation of the occurrence of intraoperative brain ischemia were 71％ and 62％,respectively (P ＜ 0.05).When the diagnostic criterion of cerebral ischemia was defincd as a decrease in the amplitude of MEPs or prolongation of the latency MEPs,the sensitivity and specificity of MEPs in estimation of the occurrence of intraoperative brain ischemia were 79 ％ and 52 ％,respectively (P ＞ 0.05).When the diagnostic criterion of cerebral ischemia was defined as a loss of the amplitude of MEPs,the sensitivity and specificity of MEPs in estimation of the occurrence of intraoperative brain ischemia were 57％ and 93％,respectively (P ＜0.05).Conclusion The sensitivity of SjvO2 and SSEPs in estimation of the occurrence of intraoperative brain ischemia is higher,however,the specificity of SjvO2 and MEPs is higher,indicating that SjvO2 is a reliable criteria for estimation of the occurrence of intraoperative brain ischemia in patients undergoing clipping of intracranial aneurysm.
