双额颞脑电双频指数在颅内动脉瘤栓塞术中的应用

Application of bilateral bispectral index monitoring during embolization of intracranial aneurysm

目的 观察颅内动脉瘤栓塞过程中双额颞脑电双频指数（BIS）的变化.方法 选取2013年4月至2014年4月收入北京天坛医院、因蛛网膜下腔出血72 h内拟行动脉瘤栓塞治疗的患者10例,记录麻醉诱导前（T1）、微导丝对位时（T2）、弹簧圈填塞时（T3）、解脱弹簧圈后（T4）4个时段5 min内BIS、有创平均动脉压（MAP）、心率的均值.结果 T1时双侧BIS均值,例10出现手术侧明显低于健侧（83.4±3.2比92.0±3.9,P＜0.05）;T2时段,2例患者手术侧BIS较健侧低（例1：41.6 ±2.7比48.6 ±4.6,例10：38.2±4.6比42.4±3.4,P＜0.05）;5例患者T3时较健侧低（例1：46.4 ±2.7比53.4±4.3,例5：41.8±1.3比49.0±2.6,例8：41.4±1.3比46.4±3.0,例9：36.6 ±3.4比41.8 ±2.4,例10：41.8±2.4比45.4±2.9,均P＜0.05）;6例患者T4时较健侧低（例1：41.2±1.6比53.8±3.8,例2：40.2±1.6比44.6±3.1,例3：42.0±5.8比50.6±6.7,例5：42.4±1.5比46.4±1.1,例9：36.6±0.8比42.4±2.5,例10：44.4±5.6比48.2±4.8,均P＜0.05）.双侧BIS、MAP及心率在T2、T3、T4时段间的变化两两比较差异均无统计学意义（P＞0.05）.术后随访,例1及例10并发脑缺血,头颅CT检查均有明确缺血梗死灶.结论 在颅内动脉瘤栓塞术中,健侧与手术侧的BIS差值对术中脑缺血的判断有指导意义,在一定程度上提示患者术后神经功能预后不良.

Objective To investigate the changes of bilateral bispectral index （BIS） during embolization of intracranial aneurysm.Methods Ten patients with subarachnoid hemorrhage from April 2013 to April 2014 who underwent embolization of intracranial aneurysm within 72 h were enrolled.The bilateral BIS,invasive mean arterial blood pressure （MAP） and heart rate （HR） were monitored continuously five minutes before anesthesia （T1）,when micro catheter navigated to the site of the aneurysm （T2）,coils deployed to fill the aneurysm （T3） and coil embolization completed （T4）.Results The bilateral BIS value was lower on the side of operation than that on the opposite side at T1 in 1 case （No.10） （83.4 ± 3.2 vs 92.0 ± 3.9,P 〈 0.05）,in 2 cases （No.1 and 10） at T2 （41.6 ± 2.7 vs 48.6±4.6,38.2 ±4.6 vs42.4±3.4,P〈0.05）,in5 cases （No.1,5,8,9 and 10） at T3（46.4±2.7 vs 53.4±4.3,41.8±1.3 vs 49.0 ±2.6,41.4±1.3 vs 46.4±3.0,36.6 ±3.4 vs 41.8±2.4,41.8 ±2.4 vs 45.4 ± 2.9,P〈0.05）,and in 6 cases （No.1,2,3,5,9,10） at T4（41.2±1.6 vs 53.8 ±3.8,40.2 ± 1.6 vs 44.6 ± 3.1,42.0±5.8 vs50.6 ±6.7,42.4 ±1.5 vs46.4±1.1,36.6±0.8 vs42.4 ±2.5,44.4±5.6 vs48.2±4.8,P〈 0.05）.There were no significantly differences regarding variables of BIS,MAP and HR among T2,T3 and T4.Two patients （No.1 and 10） had cerebral infarction after operations.Conclusion The difference of BIS values between operation side and the opposite side of the brain during embolization of intracranial aneurysm is a good indicator for cerebral ischemia,which is associated with poor postoperative neurologic function.