体感诱发电位与运动诱发电位在胸椎结核手术中联合应用的价值  

Combined application value of somatosensory evoked potentials and motor evoked potentials in thoracic vertebral tuberculosis surgery

作　　者：陈艺[1] 黎文[1] 刘琦[1] 林志雄[1] 张兴洁[2] 

机构地区：[1]广州医学院第一附属医院骨科,广东广州510120 [2]广州医学院第一附属医院麻醉科,广东广州510120

出　　处：《中国医药导报》2012年第32期58-60,共3页China Medical Herald

基　　金：广东省医学科学技术研究基金项目(项目编号:A2008265)

摘　　要：目的探讨皮层体感诱发电位(CSEP)和经头颅电刺激运动诱发电位(TES-MEP)在胸椎结核患者术中联合应用的价值。方法对27例胸椎结核患者行术中CSEP+TES-MEP联合监护。术中持续观察CSEP及TES-MEP波幅及潜伏期变化,出现波幅下降50%、潜伏期延长10%或刺激强度高于初始刺激强度100 V仍未引出者,停止手术并对症处理。结果 CSEP监测成功率为100.0%(27/27),TES-MEP监测成功率为92.6%(25/27),联合监测成功率为92.6%(25/27),CSEP阳性1例,TES-MEP阳性7例,其中,CSEP+TES-MEP均为阳性的1例,CSEP阴性而TES-MEP阳性6例,术后神经功能损伤1例。结论胸椎结核患者术中联合运用CSEP和TES-MEP监测,排除各种干扰因素后,能准确地反映术中脊髓功能状况,提高监护效果。Objective To investigate the combined application value of cortical somatosensory evoked potentials（CSEP） and transcranial electrical stimulation motor evoked potentials（TES-MEP） in thoracic vertebral tuberculosis surgery.Methods 27 cases of patients with thoracic vertebral tuberculosis were given CSEP ＋ TES-MEP monitoring during surgery.Amplitude and latency changes of CSEP and TES-MEP were observed continuously during surgery.Patients whose amplitude decreased by 50%,latency extended by 10% or 100 V stimulus intensity higher than the initial stimulus intensity yet failed to extract,were stopped the surgery and conducted symptomatic treatment.Results The success rate of CSEP monitoring was 100.0%（27/27）,which of TES-MEP was 92.6%（25/27）,and the success rate of combined monitoring was 92.6%（25/27）.CSEP showed 1 positive case and TES-MEP showed 7 positive cases,of which 1 case was positive in both CSEP and TES-MEP,6 cases were negative in CSEP and positive in TES-MEP,and 1 case was postoperative neural function injury.Conclusion Combined application of CSEP and TES-MEP in the thoracic vertebral tuberculosis surgery can accurately reflect the intraoperative spinal function and improve the monitoring effects,after excluding various interference factors.

关 键 词：皮层体感诱发电位 经颅电刺激运动诱发电位 术中监护 胸椎结核 

分 类 号：R681.5[医药卫生—骨科学]