脑电监测在颈动脉内膜剥脱术中的应用价值

Application of electroencephalogram monitoring in carotid endarterectomy

目的探讨脑电图(EEG)监测在颈动脉内膜剥脱术(CEA)中的应用价值。方法选择2016年8月至2018年6月在鹤壁市人民医院行颈动脉内膜剥脱术的21例患者为研究对象,均由颈动脉彩超和电子计算机扫描血管造影(CTA)予以确诊。所有患者均选择气管插管全身麻醉法,从麻醉诱导前至手术结束麻醉清醒,用8导联EEG监测记录。观察和记录手术前后EEG变化情况、相关处理措施以及患者的预后情况。结果颈内动脉阻断前,有5例患者出现同侧相应导联的低电压变化。颈内动脉阻断后,15例未出现新的EEG改变,而有6例出现了异常变化。其中有2例出现了双侧导联的低电压改变;1例在颈动脉阻断1 min后出现同侧导联的慢波变化,并且伴有快波幅度的轻度降低;1例颈动脉阻断30 s后出现单侧慢波变化合并显著低电压;2例出现双侧持续性慢波合并低电压变化。行相关处理后均恢复正常。术后所有患者复查脑部CT,均未见到明显脑部缺血或出血体征或症状。结论颈动脉内膜剥脱术中采用EEG监测可有效提示脑部缺血缺氧,并指导临床医师的手术操作和用药。

Objective To explore the application value of EEG monitoring in carotid endarterectomy.Methods 21 patients who underwent carotid endarterectomy in our hospital from August 2016 to June 2018 were selected as the study subjects.They were diagnosed by carotid ultrasound and CTA.All patients were given general anesthesia by tracheal intubation.From the time before induction of anesthesia to the end of operation,they were awake and recorded by 8-Lead EEG monitoring.The changes of electroencephalogram before and after operation,the relevant treatment measures and the prognosis of patients were observed and recorded.Results Before internal carotid artery occlusion,5 patients(23.81%)had low voltage changes in corresponding ipsilateral leads.After internal carotid artery occlusion,15 cases(71.43%)had no new EEG changes,while 6 cases(58.57%)had abnormal changes.Among them,2 cases had low voltage changes in bilateral leads;1 case had slow wave changes in ipsilateral leads after 1 minute of carotid artery occlusion,accompanied by a slight decrease in the amplitude of fast waves;1 case had unilateral slow wave changes with significant low voltage after 30 seconds of carotid artery occlusion;2 cases had bilateral persistent slow wave with low voltage changes.All the patients examined the CT after operation,and no obvious signs or symptoms of cerebral ischemia or hemorrhage were observed.Conclusion EEG monitoring during carotid endarterectomy can effectively indicate cerebral ischemia and hypoxia,and guide the operation and medication of clinicians.