皮层运动诱发电位监测在脑中央区术中的应用  

Application of Intraoperative monitoring of cortical motor evoked potentials in patients with central area tumour

作　　者：费智敏[1] 张珏[1] 丁赵琦[1] 周彩芳[1] 

机构地区：[1]上海交通大学医学院附属仁济医院,上海200021

出　　处：《临床神经电生理学杂志》2006年第6期338-340,380,共4页Journal of Clinical Electroneurophysiology

基　　金：上海市科委基金资助项目(编号:024119019)

摘　　要：目的:探讨在全凭静脉麻醉下,使用皮层运动诱发电位(MEP)对脑中央区手术进行术中监测的方法。方法:使用皮层电极对12例中央区肿瘤患者进行诱发电位术中监测,在中央后回感觉皮层区相应部位记录皮层体感诱发电位(SEP)的N20-P25波,沿中央后回功能区皮层向前移动电极,直至记录到一个波型相反(位相倒置)、波幅相近的波型P20-N25,将其定为运动中枢刺激点。使用高频串刺激(TS)直接刺激该点,在上肢肌肉记录MEP。结果:12例患者均能成功地记录到MEP。术中注意保护此区,术后患者症状无明显加重,被监测的上肢肌力无明显减退。结论:对于脑中央区手术,在全凭静脉麻醉下找出运动中枢刺激点并作MEP监测(术中注意保护此区)是一种优良的术中监测手段。Objective：To study direct cortical electrical stimulation technique for the recording of motor evoked potentials （MEPs） under general anesthesia in patients with central area tumour. Methods： In12 patients with intracranial lesions near or in the central area the largest N20-P25 response from postcental gyrus by intraoperative monitoring of cortical motor evoked potentials were recorded. The muscles of upper extremity in all patients were actived by delivering stimulus to cortical areas continuously. Moving the cortical electrodes forward , the largest P20-N25 response phase reversal was obtained as a motor center stimulus on SEPs. In this site of cortex, a short train stimulation elicited reproducible muscle action potentials,that could be observed from the oscilloscope without averaging. Resuits： MEPs can be recorded in all patients , pre-and-post operation. There were no worse symptoms in upper limbs. Conclusion： Such stimalation technique seems to be preferable for intraoperative monitoring of MEPs in central sulcus lesions under total intravenous anesthesia.

关 键 词：术中监测 运动诱发电位 经皮层刺激 串刺激 中央区 

分 类 号：R739.41[医药卫生—肿瘤] R741.044[医药卫生—临床医学]