脑氧饱和度联合神经电生理血压监测在颈动脉狭窄合并冠心病患者颈动脉内膜剥脱术中的临床价值

Clinical value of regional cerebral oxygen saturation combined with electrophysiological blood pressure monitoring in patients with carotid artery stenosis and coronary heart disease during carotid endarterectomy

目的探讨局部脑氧饱和度(rSO2)联合神经电生理血压监测在颈动脉狭窄合并冠心病患者颈动脉内膜剥脱术(CEA)中的脑保护与心肌保护作用。方法采用前瞻性研究的方法,将2021年6月至2022年6月金华市中心医院收治的100例颈动脉狭窄合并冠心病患者按照随机数字表法分成对照组和试验组各50例,所有患者均择期行CEA,对照组采用经验性升高基础血压20%~30%的血压管理,试验组采用以rSO2联合运动诱发电位(MEPs)及体感诱发电位(EPs)指导下的血压管理。观察两组神经功能指标[神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S100-β)]、心肌功能指标[心肌肌钙蛋白I(cTnI)、B型钠尿肽(BNP)]、临床指标(睁眼时间、拔管时间、恢复室停留时间、住院时间)以及术后并发症发生率[谵妄(POD)、认知功能障碍(POCD)、神经功能损伤]。结果两组术后NSE、S100-β均升高(P<0.05),但试验组术后NSE、S100-β低于对照组[(0.82±0.14)μg/L比(1.18±0.28)μg/L、(290.13±27.25)mg/L比(301.98±28.56)mg/L],差异有统计学意义(P<0.05);两组术后cTnI、BNP均升高(P<0.05),但试验组术后cTnI、BNP均低于对照组[(2.87±0.74)μg/L比(3.36±0.83)μg/L、(3.01±0.85)μg/L比(3.89±0.92)μg/L],差异有统计学意义(P<0.05);试验组睁眼时间、拔管时间、恢复室停留时间、住院时间均短于对照组[(16.79±3.15)min比(20.55±3.83)min、(29.38±4.66)min比(40.14±4.57)min、(66.82±15.80)min比(89.35±24.78)min、(11.24±4.89)d比(14.56±6.74)d],差异有统计学意义(P<0.05);试验组术后并发症发生率低于对照组[12.00%(6/50)比28.00%(14/50)],差异有统计学意义(P<0.05)。结论rSO2联合神经电生理血压监测在颈动脉狭窄合并冠心病患者CEA术中的应用效果较好,有脑保护与心肌保护作用,可缩短麻醉恢复时间与住院时间,降低术后并发症发生率。

Objective To investigate the effect of regional cerebral oxygen saturation(rSO2)combined with neurophysiological blood pressure monitoring on brain protection and myocardial protection during carotid endarterectomy(CEA)in patients with carotid stenosis and coronary heart disease.Methods One hundred patients with carotid artery stenosis complicated with coronary heart disease treated in Jinhua Central Hospital from June 2021 to June 2022 were randomly divided into control group and experimental group.All patients were scheduled to undergo CEA.Fifty patients in the control group were administered with empirically increasing basic blood pressure by 20%-30%,and 50 patients in the experimental group were administered with blood pressure under the guidance of rSO2 combined with motor evoked potentials(MEPs)and somatosensory evoked potentials(EPS).The neurological function indexes of the two groups[neuron specific enolase(NSE),central nerve specific protein(S100-β)],myocardial function indicators[cardiac troponin I(cTnI),B-type natriuretic peptide(BNP)],clinical indicators(eye opening time,extubation time,recovery room stay time,hospital stay)and the incidence of postoperative complications[delirium(POD),cognitive dysfunction(POCD),neurological impairment]were compard between the two groups.Results Two sets of postoperative NSE and S100-βboth increased(P<0.05),but NSE and S100 in the experimental group after surgery were lower than those in the control group:(0.82±0.14)μg/L vs.(1.18±0.28)μg/L,(290.13±27.25)mg/L vs.(301.98±28.56)mg/L,the differences were statistically significant(P<0.05).After surgery,cTnI and BNP increased in both groups(P<0.05),but the cTnI and BNP in the experimental group were lower than those in the control group:(2.87±0.74)]μg/L vs.(3.36±0.83)μg/L,(3.01±0.85)μg/L vs.(3.89±0.92)μg/L,the differences were statistically significant(P<0.05).The opening time,extubation time,recovery room stay time,and hospitalization time in the experimental group were shorter than those in the control group:(16.79±3.15)min vs.(20.55±3.83)min,(29.38±4.66)min vs.(40.14±4.57)min,(66.82±15.80)min vs.(89.35±24.78)min,(11.24±4.89)d vs.(14.56±6.74)d,there were statistical differences(P<0.05).The incidence of postoperative complications in the experimental group was lower than that in the control group:12.00%(6/50)vs.28.00%(14/50),there was statistical difference(P<0.05).Conclusions The application of rSO2 combined with neurophysiological blood pressure monitoring in CEA of patients with carotid artery stenosis and coronary heart disease has a good effect,which has brain protection and myocardial protection,can shorten the recovery time of anesthesia and hospitalization time,and reduce the incidence of postoperative complications.