EARLY DETECTION OF CEREBRAL DYSFUNCTION BY QUANTITATIVE EEG DURING CARDIOPULMONARY-BYPASS PERIOD FOR OPEN-HEART SURGERY

應用Quantitative EEG於心臟外科手術中接受體外心肺循環之病人以早期診斷中樞系統大腦傷害可行性之探討

謝仁俊(Jen-Chuen Hsieh) ； 李德譽(Tak-Yu Lee) ； 劉嘉逸(Jia-Yi Liou) ； 尹彙文(Hwei-Wen Inn) ； 王均衡(Chuen-Hen Wang) ； 楊永定(Young-Ding Yang) ； 陳國瀚(Kwok-Hon Chan) ； 呂炳榮(Ping-Wing Lui) ； 鄭國祺(Kwou-Chi Tsen) ； 游堂正(Tan-Tseng Yiou) ； 賴曉亭(Shiou-Tin Lai)

《Acta Anaesthesiologica Sinica》 28卷2期 (1990/06) Pp. 137-149

摘要

Neuropsychiatric complications are well known risks of open heart surgery. In this regard cerebral damage is caused either by microembolism or insult from low fustion pressure as a consequence of extracorporeal circulation. It seems probable that monitoring of the quantitative electroencephalography (QEEG) during the surgical procedure can help minimize the incidence of neurological sequelae through early detection. Moreover, it seems important to establish whether the pre-operative EEG has predictive value for the possible neurological outcome and whether the post-operative EEG has conclusive value for the neurological outcome and, above all to ascertain whether the peri-operative QEEG contains information valuable on the diagnosis of final neurological outcome. To elucidate the feasibility of QEEG as a means to monitor the cerebral function a study was thus undertaken. Twenty-five ASA II-V patients with age ranging from 25-79 y/o undergoing cadiac surgery under extracorporeal circulation were enrolled for study. The types of suegery varied from coronary artery by-pass graft (CABG), valvular replacement, and excision and grafting for aortic dissecting aneurysm. 16-channel EEGs were recorded wih a Cadwell Spectrum 32 in accordance with the international 10-20 system. 48 epochs (1 epoch = 2.5 seconds) of EEG recordings of pre-bypass and post-bypass periods were measured and quantitatively analyzed. Pre- & post-operatively, psyc-choneurological assessments were performed and correlated with the QEEG. The parameters employed in the study were absolute power, relative power, power asymmetry and coherence. All the results of two-session comparisons were transformed into z score values. Our preliminary study revealed that there exists a specific multivariate profile of QEEG for specific disease entity. And all the patients with z score ＜= 3.0 turned out to be free from any significant sequelate.

關鍵字

Cardiopulmonary bypass ； Cardiovascular surgery ； Quantitative EEG ； Z-score

並列摘要

心臟手術後產生神經系統後遺症是已被確認之事實，其原因或是栓塞或是體外循環灌流之不足所致。手術中應用Quantitative EEG來監測中樞神經系統以減少後遺症極其可行。本實驗旨在研究手術中使用數位化訊號分析之技術，利用Quantitative EEG於手術中早期診斷之可行性。研究結果顯示，當病人仍然處於麻醉狀態及手術中時，QEEG即已呈現異常結果，並且不同之症候羣各有相異之QEEG profile。Z-score小於3者，其臨床預後均無後遺症。初期研究認爲Quantitative＆Topographic-al EEG Mapping用於手術與麻醉下神經系統完整性之監測極具展望。