颈动脉内膜切除术中电生理监测的应用价值  

Investigation of the application value of electrophysiological monitoring during carotid endarterectomy

作　　者：安庆祝[1] 雷宇[1] 许耿[1] 顾宇翔[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040

出　　处：《中国脑血管病杂志》2013年第9期468-471,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨颈动脉内膜切除术(CEA)中电生理监测的应用价值。方法回顾性分析2012年6月—2013年1月在复旦大学附属华山医院接受CEA且术中进行电生理监测的13例患者临床资料,分析其脑电图(EEG)、体感诱发电位(SEP)、运动诱发电位(MEP)等电生理指标,以决定在术中是否应用颈动脉转流管。结果 11例患者电生理监测未见明显异常。对2例颈内动脉临时阻断后EEG波幅降低>50%、SEP潜伏期延长>10%的患者,在术中应用了颈动脉转流管,其MEP监测结果未见明显变化。所有患者均无卒中、心肌梗死等术后严重并发症。结论术中电生理以EEG监测对CEA是否应用转流管最具有指导作用,SEP潜伏期监测与EEG监测具有一致性,而MEP的敏感性较差。术中电生理监测有利于决定手术策略,避免手术相关性缺血并发症的发生。Objective To investigate the application value of electrophysiological monitoring during carotid endarterectomy （CEA）. Methods Thirteen patients who were treated with CEA and performed intraoperative electrophysiological monitoring records at Shanghai Huashan Hospital, Fudan University from June 2012 to January 2013 were analyzed retrospectively. Their electrophysiological parameters, such as e- lectroencephalography （EEG）, somatosensory evoked potential （SEP）, and motor evoked potential （MEP） were analyzed in order to decide whether using carotid shunt or not. Results The electrophysio- logical monitoring of 11 patients showed no obvious abnormal. After temporary occlusion of internal carotid arte^-y in 2 patients, the decrease of EEG amplitudes was more than 50% of normal value. The patients whose SEP latency was prolonged for more than 10% used carotid shunt during procedure. Their MEP mo- nitoring results did not have significant change. All patients did not have apparent stroke, myocardial in- farction, and other serious complications after procedure. Conclusion Whether using shunt for CEA with EEG monitoring has the most guiding role during the intraoperative electrophysiological monitoring. The SEP latency monitoring and the EEG monitoring are consistent, and the sensitivity of MEP is poor. Intraop- erative electrophysiological monitoring helps deternine the surgical strategy and avoids surgical complica- tions.

关 键 词：颈动脉内膜切除术 脑电图 电生理监测学 

分 类 号：R743.3[医药卫生—神经病学与精神病学]