体感诱发电位监测颈动脉内膜剥脱术(附237例分析)  

Somatosensory evoked potential monitoring during carotid endarterectomy:analysis of 237 cases

作　　者：姜燕[1] 卜博[1] 

机构地区：[1]中国人民解放军总医院神经外科,北京100853

出　　处：《中国微侵袭神经外科杂志》2009年第11期502-503,共2页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的总结颈动脉内膜剥脱术中使用体感诱发电位(SEP)监测颈动脉阻断后脑灌注状态的经验,探讨术中转流指征。方法对237例颈动脉内膜剥脱术病人行术中SEP监测,采用胫后神经刺激,记录双侧皮质SEP。将P40波幅下降50%作为脑缺血的预警信号,潜伏期延长3ms作为参考。结果P40分为Ⅰ型(波形无变化)142例,Ⅱ型(波形变化但逐渐恢复)81例,Ⅲ型(波形变化且无恢复)11例,Ⅳ型(波形扁平且无恢复)3例,Ⅴ型(波形消失)0例。对9例波幅下降>50%且升高血压后无恢复的Ⅱ型病人及14例Ⅲ、Ⅳ型病人行转流。本组术后均未出现脑缺血性并发症。结论SEP监测十分敏感,可提示颈动脉阻断后的脑灌注状态,了解是否需行转流,是颈动脉内膜剥脱术中监测的理想手段。Objective To summarize the clinical experiences with intraoperative somatosensory evoked potential （SEP） for monitoring cerebral perfusion state after carotid occlusion, and explore the indications for intraoperative arterial shunts. Methods Two hundred and thirty seven patients undergoing carotid endarterectomy with intraoperative SEP monitoring were reviewed retrospectively. Posterior tibial nerve stimulation was employed to record the bilateral cortical SEP. P40 amplitude decrease by 50% was considered as a sign of ischemia, and 3 ms prolongation of latency used as a reference. Results Type Ⅰ SEP waveform （no changes of P40） was seen in 142 patients, type Ⅱ （P40 changes with gradual recovery） in 81, type Ⅲ （P40 changes without recovery） in 11, and type IV （fiat waveform of P40 without recovery） in 3. No patients had type V SEP waveform （P40 disappearance）. Of type Ⅱ patients, 9 received arterial shunts whose P40 amplitude dropped below 50% and had no recovery after elevation of blood pressure; all of the 14 type Ⅲ -Ⅳ patients received arterial shunts. No complication as cerebral ischemia was observed. Condusion SEP monitoring is a very sensitive and ideal technique for indicating the cerebral perfusion state after carotid occlusion and estimating whether arterial shunt is necessary.

关 键 词：颈动脉内膜切除术 诱发电位 躯体感觉 监测 手术中 

分 类 号：R651.12[医药卫生—外科学]