体感诱发电位与运动诱发电位监测在颈椎手术中的应用价值  

Application value of somatosensory evoked potential and motor evoked potential monitoring in the cervical spine surgery

作　　者：席志鹏[1] 谢林[1] 康然[1] 陈方庆[1] 孙道喜[1] 

机构地区：[1]江苏省中西医结合医院骨伤科,南京210028

出　　处：《中国当代医药》2014年第29期42-46,共5页China Modern Medicine

基　　金：江苏省临床医学科技专项项目(BL2012069);江苏省中医药领军人才项目(RC1004)

摘　　要：目的 探讨体感诱发电位和运动诱发电位监测在颈椎手术中的临床应用价值.方法 总结回顾了2011年3月～2014年3月28例接受颈椎手术患者的术中监测结果,术中对患者进行MEP、SEP监测,观察手术、麻醉事件对SEP、MEP潜伏期及波幅的影响,并以术前、术后JOA评分评估疗效.结果 3例术后波形改善,1例术中未观察到MEP,其余24例术前、术中、术后波形无明显阳性改变;术后患者均恢复良好,术前、术后的JOA评分比较,差异有统计学意义（P＜0.01）;麻醉深度可对SEP波形产生影响,肌松剂可对MEP波形产生影响,低血压可使SEP、MEP波形发生改变,脊柱手术中的操作可引起SEP、MEP改变.结论 MEP、SEP进行术中监测具有安全性、可靠性和敏感性,可以帮助监测和减少术中脊髓神经损伤,因此,建议将SEP、MEP术中监测常规运用于颈椎手术中.Objective To discuss the clinical application value of somatosensory evoked potential （SEP） and motor evoked potential （MEP） monitoring in the cervical spinal surgery. Methods The monitoring results during operation in 28 patients with cervical surgery From March 2011 to March 2014 were summarized and reviewed,and patients were given SEP and MEP monitoring during operation,the influence of the operation and anesthesia event on the latency and amplitude of the SEP and MEP was observed,the curative effect was evaluated by JOA score before and after operation. Results There was postoperative waveform improvement in 3 cases,MEP was not observed in 1 case during operation, preoperative,intraoperative,postoperative waveform had no obvious positive change in another 24 cases;all patients recovered well after operation;there was a statistical difference of JOA score before and after operation （P〈0.01）;anesthesia depth could have an impact on the SEP waveform,muscle relaxants could affect MEP waveform,low blood pressure could make SEP,MEP waveform change,the operation in spinal operation could cause SEP,MEP change. Conclusion MEP,SEP monitoring during operation has the advantages of safety,reliability and sensitivity,and it can help to monitor and reduce the spinal cord nerve injury during surgery,so it is recommended that SEP and MEP intraoperative monitoring can be used routinely in cervical operation.

关 键 词：体感诱发电位 运动诱发电位 颈椎手术 脊髓神经损伤 

分 类 号：R741.044[医药卫生—神经病学与精神病学]