多模式神经电生理监测在脊柱手术中报警因素分析  

ANALYSIS OF THE ALARM FACTORS DURING MULTIMODE ELECTRONEUROPHYSIOLOGIC MONITORING IN SPINAl SUREGRY

作　　者：张玉新[1] 何帆[1] 王珏[1] 

机构地区：[1]江苏省中医院功能科,210029

出　　处：《现代电生理学杂志》2014年第4期199-203,共5页Journal of Modern Electrophysiology

摘　　要：目的:分析多模式神经电生理监测在脊柱手术中的各种报警因素,减少假阳性报警。方法:对243例不同类型脊柱手术病例进行体感诱发电位(Somatosensory Evoked Potentials,SSEPs)、运动诱发电位(Motor Evoked Potentials,MEPs)、自由肌电图(free-run,EMG)、四联刺激肌肉收缩试验(Train of four Twitch test,TOF)等多模式神经电生理监测,实时记录各种报警事件、血压、出血量、体温、麻醉药物及术后的感觉运动功能。结果:243例病例术中SSEPs预警率46.9%(114/243),MEPs预警率28.0%(68/243),EMG预警率72.8%(177/243)。经分析排除假阳性后总的真实报警率68.7%(167/243),其中SSEPs报警率23.9%(58/243),MEPs报警率12.8%(31/243),EMG报警率32%(78/243)。所有术后均无严重的神经系统并发症。结论:在脊柱手术中常发生各种报警事件,其中大部分是由于外界各种干扰因素造成的"假阳性"事件,若不加以分析判断均予以报警会严重干扰手术进程。因此神经电生理监测医生要仔细分析各种因素排除干扰,以提高脊髓功能监测结果的准确性。Objective： To analyze the various alarm factors of muhimode electroneurophysiologic monitoring in spinal surgery to decrease false positive alarm of multimode electroneurophysiologic monitoring Methods： 243 cases were observed by muhimode electroneurophysiologic monitoring including SSEPs, MEPs, EMG and TOF in different spinal surgeries and recorded every alarm event, blood pressure,blood lose, anesthetics,real-time body temperature and function of sensory and motor after surgery. Results： 114 cases （46.9%） early warning were. SSEPs, 68 cases （28.0%） early warning were MEPs,177 cases （72.8%） early warning were EMC. There was no postoperative neruologic complications. Conclusion： There are various alarm events in spinal surgery,most of them are false positive alarms, so we should analyze the various alarm factors carefully and eliminate interference, then make more acurate conclusion.

关 键 词：多模式神经电生理监测 报警 脊柱手术 

分 类 号：R687.3[医药卫生—骨科学] R741.044[医药卫生—外科学]