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目的探讨通过Vigileo监护仪与Presep导管进行实时颈内静脉球部血氧饱和度(jugular bulb venous oxygen saturation,SjvO2)监测与传统间断抽血法的相关性,及其与经颅超声多普勒(transcranial doppler,TCD)相比在全麻下预警颈动脉内膜剥脱术(carotid endarterectomy,CEA)中脑缺血的可行性。方法 40例全麻下行单侧标准CEA患者在麻醉诱导后置入Presep导管至患侧颈内静脉球部,分别于手术开始前、颈动脉夹闭15min、颈动脉开放15min时抽取颈内静脉球部血液检测SjvO2,并与Vigileo监护仪所测值进行相关分析。同时记录术中颈动脉夹闭时患侧SjvO2的变化,与TCD进行诊断一致性检验。结果实时监测获得SjvO2与间断抽血测得的SjvO2具有线性正相关性(r=0.483,P=0.000)。线性回归方程为SjvO2(实时)=41.33+0.47×SjvO2(血气)(F=31.93,P=0.000);颈动脉夹闭后SjvO2变化与患侧大脑中动脉血流速度变化不具有相关性(P=0.106);SjvO2<50%与TCD对术中脑缺血的诊断具有一致性(Kappa=0.186,P=0.043);SjvO2下降、绝对值下降超过5%、绝对值下降超过10%时与TCD对术中脑缺血的诊断缺乏一致性(Kappa=0.179、0.098、0.231,P=0.256、0.553、0.114)。结论采用Presep导管进行实时SjvO2监测或许可以替代间断抽血检测方法,当前证据尚不支持单独以SjvO2作为全麻CEA中预测脑缺血的指标。
Objective To investigate the correlation between real-time monitoring of jugular bulb venous oxygen saturation (SjvO2) and traditional intermittent blood sampling by Vigileo monitor and Presep catheter, and to evaluate the relationship between transcranial ultrasound Doppler transcranial doppler, TCD) compared to general anesthesia in carotid endarterectomy (carotid endarterectomy, CEA) in the feasibility of cerebral ischemia. Methods Forty patients undergoing general anesthesia with unilateral standard CEA underwent induction of anesthesia with Presep catheter into the ipsilateral jugular bulb. The jugular bulb was removed at 15 min before carotid artery occlusion and 15 min after the carotid artery was opened The blood was tested for SjvO2 and correlated with the Vigileo monitor values. At the same time recording intraoperative carotid artery occlusion of SjvO2 changes in the affected side, and TCD diagnostic consistency test. Results There was a linear positive correlation between SjvO2 measured by real-time monitoring and SjvO2 measured by intermittent blood sampling (r = 0.483, P = 0.000). The linear regression equation was SjvO2 (real time) = 41.33 + 0.47 × SjvO2 (F = 31.93, P = 0.000). The change of SjvO2 after carotid artery occlusion had no correlation with the change of blood flow velocity of the affected side middle cerebral artery = 0.106). SjvO2 <50% was consistent with TCD in the diagnosis of intraoperative cerebral ischemia (Kappa = 0.186, P = 0.043); SjvO2 decreased, absolute value decreased more than 5%, while absolute value decreased more than 10% There was a lack of consistency in the diagnosis of intraoperative cerebral ischemia (Kappa = 0.179, 0.098, 0.231, P = 0.256, 0.553, 0.114). Conclusions Real-time SjvO2 monitoring using Presep catheters may be an alternative to intermittent blood sampling, and current evidence does not support the use of SjvO2 alone as a predictor of cerebral ischemia in CEA.