颅内前循环动脉瘤术中诱发电位监测效果评估  

Evaluation of monitoring of evoked potentials in surgery of anterior circulation aneurysms

作　　者：陶晓蓉[1] 乔慧[1] 王硕[2] 王明然[1] 刘莉[1] 杨丽蕊[1] 

机构地区：[1]西部医科大学北京市神经外科研究所,100050 [2]首都医科大学附属北京天坛医院

出　　处：《中华神经外科杂志》2010年第12期1059-1062,共4页Chinese Journal of Neurosurgery

基　　金：卫生部卫生公益性行业科研专项项目（200902004-13）

摘　　要：目的 探讨全静脉麻醉下经颅电刺激运动诱发电位（TES-MEPs）联合体感诱发电位（SEP）监测颅内前循环动脉瘤手术及预防缺血性卒中的应用价值.方法 47例颅内动脉瘤夹闭手术患者,术中行SEP和TES-MEPs联合监测,以神经功能检查作为评价指标,比较术前和术后神经功能的改变和诱发电位变化之间的关系.结果 43例神经功能未见显著改变,4例神经功能出现不同程度下降,其中3例MEP及SEP同时出现波幅下降＞50%或消失,且手术结束时未恢复至基线水平,与术后神经功能障碍发生具有一致性.结论 术中监测指标的改变可较早地获得脑缺血的证据,联合SEP与MEP监测有利于降低术后缺血性脑卒中的发生.Objective To investigate the value of combined monitoring of motor evoked potentials （MEP） and somatosensory evoked potentials （SEP） on the prevention of ischemic stroke in anterior circulation aneurysms surgery under total intravenous anesthesia. Method 47 patients of anterior circulation aneurysms were monitored SEP and MEP during the operation,the postoperative and preoperative neurological function variation and the relationship with monitoring outcome were compared.Result There was no significant change in neurological function in 91% patients（43/47）.In 4/47 （9%） patients,we observed decreased nerve function with different degrees. Among these 4 patients,3 with motor evoked potentials and somatosensory evoked potentials amplitude declined〉50% or disappeared simultaneously,moreover there was no recovery to baseline level after surgery,which were consistent with postoperative neurological deficit.Conclusion The changes of intraoperative monitoring indicators can be obtained for earlier indication of cerebral ischemia.The combined monitoring of SEP and TES-MEPs could improve the outcomes significantly for patients with aneurysms.It might be helpful to avoid postoperative ischemic stroke.

关 键 词：颅内动脉瘤 体感诱发电位 运动诱发电位 术中监测 临时阻断 

分 类 号：R686[医药卫生—骨科学]