颈动脉内膜切除术中SjO_2持续监测的临床研究

Clinical study on continuous monitoring of jugular bulb venous oxygen saturation during carotid endarterectomy

目的 研究颈动脉内膜切除术 (CEA)中颈内静脉血氧饱和度 (SjO2 )持续监测脑灌注压的可行性。方法 测定 40例CEA病人颈动脉楔压 (SP)及连续监测颈动脉夹闭后 10分钟内SjO2和体感诱发电位 (SEP)的变化情况 结果 SEP波幅和SP之间无相关关系 (r=0 16 ,P =0 2 5 )。夹闭颈动脉后SjO2 从 70 %降到 6 4% (P <0 0 1)。SEP波幅同时从 2 0 μV降到 1 6 μV (P <0 0 1)。放开夹闭后 ,SjO2 从 6 5 %升到 70 % (P <0 0 1) ,SEP也从 1 6 μV升到 1 9μV (P <0 0 1)。SEP波幅变化比和SjO2 呈相关关系 (r =0 6 6 ,P <0 0 0 1)。结论 SjO2 的连续监测可用于颈动脉内膜切除术而且在预测颈动脉夹闭所致脑的低灌注方面优于SP检测法。

Objective To examine whether continous monitoring of jugular bulb venous oxygen saturation (SjO 2) is applicable for the evaluation of cerebral hypoperfusion during carotid endarterectomy (CEA). Methods The subjects were 40 patients who underwent elective CEA under general anaesthesia. After the carotid stump pressure(SP) was measured, SjO 2 and the somatosensory evoked potientials(SEP) were monitored during the carotid test clamping for 10 min. Results There was no alteration in cardiovascular and respiratory status during the test clamping. No correlation was observed between SEP amplitude and SP(r=0 16,P=0 25). However, at clamping, SjO 2 decreased from 70% to 64%(P<0 01) with a reduction in SEP amplitude from 2 0 to 1 6μV(P<0 01). After declamping, SjO 2 increased from 65% to 70% (P<0 001). accompanied with a recovery in SEP from 1 6 to 1 9μV ((P<0 01). The changes in SEP amplitude and SjO 2 correlated (r=0 66,P<0 01).Conclusions Continuous monitoring of SjO 2 is superior to SP measurement in the prediction of cerebral hypoperfusion caused by carotid clamping. It could be used during CEA.