颈脊髓损伤患者应用体感诱发电位监测的价值  

Value of Somatosensory Evoked Potential Monitoring in Cervical Spinal Cord Injury Patients

作　　者：龙海波[1] 康建平[1] 冯大雄[1] 叶飞[1] 张戈[2] 雷飞[1] 周云龙[1] 周庆忠[1] 杨剑[1] 

机构地区：[1]泸州医学院附属医院脊柱外科,四川泸州646000 [2]泸州市人民医院骨科

出　　处：《华西医学》2013年第3期356-360,共5页West China Medical Journal

摘　　要：目的探讨躯体感觉诱发电位(SEP)在颈脊髓损伤术前、术中监测的意义。方法纳入2010年1月-2012年4月治疗的241例颈脊髓损伤患者,术前按美国脊柱脊髓损伤协会(ASIA)评分并分级,确定损伤平面。术前与术中SEP监测,分析不同损伤分级以及不同损伤平面术前的波幅及潜伏期的差异,术中SEP监测以波幅下降>50%和或潜伏期延长>10%为预警标准。结果各损伤分级组术前SEP监测:A级组SEP波消失,呈一直线,而B、C、D、E级组均测出SEP波形,根据是否可测出SEP波形,可将A级与B、C、D、E及组区别。B、C、D级组之间波幅和潜伏期均无统计学意义(P>0.05)。E级组较B、C、D级组波幅增高、潜伏期缩短,差异有统计学意义(P<0.05);不完全性颈脊髓损伤组内不同损伤平面组之间波幅和潜伏期差异均无统计学意义(P>0.05)。术中SEP对脊髓功能损伤监测的灵敏度83.3%、特异度98.7%。其中术中:SEP阳性8例,真阳性5例,4例术者处理后波幅及潜伏期回复至正常范围,术后无新的神经功能损伤,另1例术者采取各种处理后波幅及潜伏期无恢复,术后神经功能损伤较术前加重;假阳性3例,1例麻醉师给予升高血压后波形恢复至正常,另2例经麻醉师调整麻醉深度后波形恢复正常,此3例术后无新的神经功能损伤。SEP阴性233例,真阴性232例,术后无新的神经功能损伤;假阴性1例,患者术中、术后波形未见异常,术后运动功能损伤程度较术前加重。结论①SEP能准确评估完全性和不完性颈脊髓损伤,但对不完全性颈脊髓损伤的损伤程度不能作出准确评估、也不能区分颈脊髓损伤的损伤平面;②术中SEP监测能较好地反映颈脊髓功能完整性,对减少颈脊髓损伤术中发生医源性颈脊髓损伤风险具有重要意义。Objective To investigate the value of preoperative and intraoperative somatosensory evoked potential（SEP） monitoring in cervical spinal cord injury（SCI） patients.Methods A total of 241 patients with cervical SCI treated in our department between January 2010 and April 2012 were scored and graded according to ASIA standard.Preoperative and intraoperative SEP monitoring was performed.The statistical differences of latency and amplitude of preoperative SEP in different ASIA impairment scale as well as at different injury level were analyzed.The value of intraoperative SEP in monitoring the spinal cord functional integrity（the potentials were observed with the value of the latency extension more than 10% and/or peak amplitude reduction more than 50% defined as abnormality） was assessed.Results The preoperative SEP of ASIA A disappeared.The wave amplitude and latency in ASIA A was different from that in ASIA B,C,D and E,but there was no difference in amplitude among ASIA B,C and D（P 0.05）.There was also no difference in amplitude at different injury levels in incomplete injury patients（P 0.05）.There was no difference in latency among ASIA B,C and D（P 0.05）.Meanwhile,there was no difference in latency at different injury levels in incomplete injury patients（P 0.05）.About five patients presented true positive responses.All patients were dealt with immediately when SEP changed to abnormal criteria.One patient had new neurological deficit after the operation while the other four patients didn’t.About three patients presented false positive responses among whom one had waveform returned to normal after performing hypertension and the other two had waveform returned to normal after modifying the depth of anesthesia.There was not new neurological deficit after the operation for the three patients.About 232 patients presented true negative responses and were without new neurological deficit after the operation.One patient presented false negative responses.This case showed no intraoperative SEP a

关 键 词：脊髓损伤 诱发电位 躯体感觉 监测 手术中 

分 类 号：R651.2[医药卫生—外科学]