SEP监测在甲基泼尼松龙防治脊髓损伤中的作用  

THE EFFECT OF MONITORING OF SEP DURING THE TREATMENT OF SPINAL CORD INJURY BY METHYLPREDNISOLONE

作　　者：齐宗华[1] 刘勇[1] 赵洪贞[1] 郑文艳[1] 

机构地区：[1]青岛大学医学院附属医院骨科研究所,山东青岛266003

出　　处：《青岛大学医学院学报》2008年第4期349-351,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨脊柱手术中体感诱发电位(SEP)监测脊髓功能在指导甲基泼尼松龙(MP)大剂量冲击治疗脊髓损伤中的价值。方法颈、胸椎手术病人280例,术前SEP正常术中SEP变化未达到预警标准168例。术前SEP异常术中SEP变化未达到预警标准80例,分为两组,A1组40例术中应用大剂量MP冲击疗法,B1组40例应用甘露醇和地塞米松常规治疗,观察两组早期脊髓功能改善情况。SEP术中达到预警标准32例分为两组:A2组22例治疗同A1组,B2组10例治疗同B1组,观察两组早期脊髓功能改善情况。结果SEP术中未达到预警标准术前无SEP异常者168例,术后无脊髓损伤症状。A1组与B1组比较,神经症状改善情况无显著统计学差异。A2组与B2组比较,神经症状改善情况有显著性差异(P=0.005)。结论SEP术中监测达到预警标准,高度怀疑脊髓受到损伤时,及时应用大剂量MP可有效防治脊髓继发性损伤的发生、发展,促进脊髓功能恢复。而对已有的脊髓慢性损伤,术前SEP异常,但术中SEP监测未达到预警标准,应用MP冲击治疗效果欠佳。Objective To evaluate the clinical value of somatosensory evoked potential （SEP） in monitoring the function of spinal cord and guiding the use of methylprednisolone pulse therapy during surgery for spinal cord injury. Methods Among 280 cases of cervical and thoracic operation, 168 showed normal SEP preoperatively but the changes did not reached the precaution standard at surgery, 80 showed abnormal SEP preoperatively and the changes of SEP at operation did not reached the precaution standard. The latter 80 cases were evenly divided into two groups： group A1, treated with methylprednisolone pulse therapy; group B1, received routine treatment with mannitol and dexamethasone. For those 32 cases which reached the precaution standard at operation were divided into two groups： group A2 （22 cases） and group B2 （10）. Group A2 got the same therapy as group A1, group B2 received the same therapy as group B1. The early stage improvement of spinal cord function of the above four groups was observed. Results For 168 cases with normal preoperativeSEP but did not reached the precaution standard value of SEPat operation showed no symptoms of spinal cord injury. There was no significant differences between group A1 and groupB1 in terms of the improvement of neurological symptoms; while the differences between group A2 and group B2 were statistically different （P= 0. 005）. Conclusion When SEP reached presentiment standard, which highly suggested spinal cord injury, high dose of methyl prednisolone should be given to prevent further spinal cord injury and promote the recovery of spinal cord function, For those with chronic injury, suggestive of abnormal preoperative SEP and lower than-presentiment standard SEP at operation, methypredinisolone pulse therapy is below the mark.

关 键 词：诱发电位 躯体感觉 脊髓损伤 甲基泼尼松龙 治疗结果 

分 类 号：R651.2[医药卫生—外科学]