躯体感觉诱发电位监测在颈动脉内膜切除术中的应用  

Application of Intraoperative Somatosensory Evoked Potential Monitoring in Carotid Endarterectomy

作　　者：曹志恺[1] 吕建平[1] 全伟[1] 张昊[1] 钟文军[1] 骆锦标[1] 

机构地区：[1]广州医学院附属广州市第一人民医院神经外科,广州510180

出　　处：《中国卒中杂志》2013年第1期20-24,共5页Chinese Journal of Stroke

摘　　要：目的探讨躯体感觉诱发电位(somatosensory evoked potential,SEP)监测在颈动脉内膜切除术中的应用价值。方法回顾性分析2010年1月～2012年1月广州市第一人民医院住院的10例颈动脉硬化性狭窄患者,行颈动脉内膜切除术,术中测量颈动脉残端压(stump pressure,SP)和监测SEP中N20的波幅及潜伏期变化情况后,决定是否放置转流管。比较患者术前和术后6个月改良Rankin评分(modified Rankin Scale,mRS)、美国国立卫生院卒中评分(National Institutes of Health Stroke Scale,NIHSS)和管腔狭窄变化情况。结果 10例患者中,5例患者同时出现SP低于50mmHg和SEP波幅下降超过50%,予以放置转流管;3例患者SP超过50mmHg,但SEP波幅下降超过50%,予以放置转流管;2例患者SP超过50 mmHg,但SEP波幅及潜伏期改变不明显,未放置转流管。所有患者手术均获得成功。患者术后6个月mRS评分较术前下降[1(四分位数范围0.5～1.5)vs 2(四分位数范围1～2.5),P=0.03];术后6个月NIHSS评分和术前比较差异无显著性(P=0.06);术后6个月管腔狭窄程度较术前改善,差异有显著性[(6.8±2.5)%vs(87.5±8.6)%,P<0.001]。结论 SEP监测可能有助于避免颈动脉内膜切除术后神经功能缺损的发生,SEP监测下行颈动脉内膜切除术可能相对安全有效。Objective To investigate the value of somatosensory evoked potcntial（SEP） monitoring in carotid endarterectomy（CEA）. Methods Ten patients who underwent CEA for carotid atherosclerosis were retrospectively analyzed in Guangzhou First People＇s Hospital from January 2010 to January 2012. Carotid artery stump pressure（SP） was measured and the placement of intraluminal shunt was determined by the changes of the N20 in SEP and its latent time monitored during the operation. Their neurological function before and 6 months after surgery were evaluated with modified Rankin Scale（mRS）, National Institutes of Health Stroke Scale（NIHSS） and the severity of diameter stenosis. Results Out of 10 patients, in 5 patients the fluctuation was decreased by 50%, stump pressure was less than 50 mmHg, and intraluminal shunt technique was used; in 3 patients the fluctuation was decreased by 50%, stump pressure was more than 50 mmHg, and intraluminal shunt technique was also adopted; in 2 patients few changes in the fluctuation occurred, stump pressure was more than 50 mmHg, and intraluminal shunt technique was not performed. All patients successfully underwent the operation, and no mortality occurred. There was statistical difference in the mRS score between pre-operation and 6 months after surgery（l[quartile 0.5-1.5] vs 2[quartile 1-2.5], P=0.03）. There was no significant difference in the NIHSS score（P=0.06） Compared with that of pre-procedure（87.5±8.6）%, the residual stenosis after surgery was significantly improved（6.8±2.5）%（P〈0.001）.Conclusion SEP monitoring may be useful for preventing neurologic deficit after CEA. CEA with SEP monitoring may be relatively safe and effective.

关 键 词：颈动脉内膜切除术 躯体感觉诱发电位 监测 

分 类 号：R651[医药卫生—外科学]