Evaluation of the brain hemodynamic response by means of near-infrared spectroscopy (NIRS) monitoring in patients with atherosclerotic carotid disease undergoing endarterectomy

Abstract Backgrounds Near-infrared spectroscopy (NIRS) is non-invasive technique that detects hemodynamic alterations in tissues. It enables continuous monitoring of intracerebral vascular physiologic information. Due to its portable nature, NIRS may be used bedside or in the operating room. Objectives To evaluate use of NIRS for intraoperative monitoring of the brain hemodynamic response, during carotid endarterectomy. Methods 10 patients with atherosclerotic carotid disease scheduled for endarterectomy were evaluated. After patients had been selected, they answered a questionnaire on epidemiological data and information about comorbidities and then carotid disease was confirmed with diagnostic methods. NRIS monitoring was used during the surgical procedure. The variables analyzed before, during and after carotid clamping were oxygen saturation (SatO2), total hemoglobin (THb), reduced hemoglobin (RHb), and oxyhemoglobin (OHb). A p value of <0.05 was considered statistically significant. Results The results obtained from NIRS show that RHb and SatO2 vary during the different stages of surgery. RHb levels are higher during clamping, when compared with the other two surgical stages. On the other hand, SatO2 is lower during clamping. Conclusions During carotid endarterectomy, NIRS is a feasible, real-time, and non-invasive intracranial monitoring method that accurately and reliably measures the changes in intracerebral capillary hemodynamic conditions.

【摘要】
研究背景：近红外光谱（Near-infrared spectroscopy, NIRS）是一种无创检测技术，可检测组织内的血流动力学变化，实现颅内血管生理信息的持续监测。由于其具备便携特性，NIRS可在病床旁或手术室中开展应用。
研究目的：评估NIRS在颈动脉内膜切除术术中监测脑血流动力学反应的应用价值。
研究方法：本研究纳入10例拟行颈动脉内膜切除术的动脉粥样硬化性颈动脉疾病患者。患者入组后，首先填写涵盖流行病学资料与合并症信息的问卷，随后通过诊断手段确认颈动脉疾病诊断。手术过程中采用NIRS进行监测，分析指标包括颈动脉夹闭前、术中及术后的血氧饱和度（oxygen saturation, SatO2）、总血红蛋白（total hemoglobin, THb）、去氧血红蛋白（reduced hemoglobin, RHb）以及氧合血红蛋白（oxyhemoglobin, OHb）。以p值<0.05为差异具有统计学意义。
研究结果：NIRS监测结果显示，RHb与SatO2在手术不同阶段存在明显变化。与其余两个手术阶段相比，夹闭颈动脉时RHb水平更高；与此同时，夹闭颈动脉时SatO2水平更低。
研究结论：在颈动脉内膜切除术术中，NIRS是一种可行、实时且无创的颅内监测手段，可精准可靠地检测脑内毛细血管血流动力学状态的变化。