颈胸椎手术中体感诱发电位监护的影响因素分析及准确性观察  

Accuracy and related affecting factors of somatosensory evoked potential monitoring in cervical and thoracic surgery

作　　者：齐宗华[1] 西永明[1] 刘勇[1] 王德春[1] 

机构地区：[1]青岛大学医学院附属医院山东省创伤骨科研究所,266003

出　　处：《中华外科杂志》2007年第4期240-242,共3页Chinese Journal of Surgery

摘　　要：目的探讨体感诱发电位监护在颈、胸椎手术中的应用价值,对其准确性及影响因素进行分析。方法颈、胸椎疾病患者采用皮层体感诱发电位(CSEP)及皮层下体感诱发电位(Sub-CSEP)术中监测,根据麻醉前、后及不同手术阶段体感诱发电位的变化与术后功能相结合,判断体感诱发电位(SEP)的准确性。结果麻醉因素引起的 SEP 波幅降低主要影响 CSEP,双侧刺激均改变,但基本未达到手术预警标准值,而 Sub-SEP 变化不明显。手术高危操作侵及脊髓,SEP 波幅降低主要影响高危操作的同侧,表现为同侧 CSEP 及 Sub-CSEP 波幅同时降低,并且降低幅度较大,达到预警标准值,而对侧 CSEP 及 Sub-CSEP 波幅变化不甚明显。其他非手术原因如低体温、局部冷盐水冲洗脊髓,引起 SEP 潜伏期延长,波幅变化不明显。失血过多致平均动脉压降低可引起 SEP 波幅降低,潜伏期变化不明显。局部低温及低血压引起的 SEP 改变,均未达到预警标准值。结论颈、胸椎手术中采用体感诱发电位监测排除各种干扰,可较准确地反映脊髓的生理或病理状况。Objective To evaluate the accuracy and related affecting factors of the intra-operative somatosensory evoked potential monitoring in cervical and thoracic surgery. Methods Cortical somatosensory evoked potential （CSEP） monitoring and sub cortical somatosensory evoked potential （ Sub- CSEP ） monitoring were performed in cervical and thoracic surgery. Somatoseusory evoked potential （SEP） changes were recorded during anaesthesia and operation and postoperative, which could be used to evaluate accuracy of SEP. Results Bilateral CSEP wave abnormalities were related to anaesthesia, decreasing wave amplitudes did not reach the alarming standard. Intra-oporative manipulation to affect spinal cord would influence isolateral wave abnormality of CSEP and sub-CSEP, decreasing amplitudes reached the alarming standard. Local hypothermia such as cold water irrigating spinal cord would be to prolong the latent period. Low mean arterial pressure （MAP） mostly influenced amplitudes. Changes of SEP in local hypothermia and MAP did not reach the alarming standard. Conclusions CSEP and Sub CSEP can reflex physiopathological condition of spinal cord, it is useful in evaluating spinal cord function and providing the safety for cervical and thoracic surgery.

关 键 词：外科手术 颈胸椎 皮层体感诱发电位 皮层下体感诱发电位 脊髓监护 

分 类 号：R687.3[医药卫生—骨科学]