脊柱侧凸手术中躯体感觉诱发电位监护的基线选择与警戒标准  

Baseline and alert level of somatosensory evoked potential monitoring in scoliosis surgery

作　　者：齐华光[1] 李佳良[1] 王雨晨[1] 郑丽萍[1] 贠阳[1] 刘雪梅[1] 宋潇[1] 袁涛[1] 

机构地区：[1]西安交通大学医学院附属红会医院功能检查科,710054

出　　处：《中华医学杂志》2015年第21期1655-1658,共4页National Medical Journal of China

摘　　要：目的 通过对脊柱侧凸手术术中躯体感觉诱发电位（SEP）监护波形进行分析,记录术后神经功能状态,探讨基线的选择时机和警戒标准,以更精确地指导手术.方法 回顾性分析西安交通大学附属红会医院2011年3月至2014年12月间收治的113例接受手术治疗的脊柱侧凸患者,比较麻醉后切皮前（以下简称麻醉后）和暴露椎板后（以下简称暴露后）的SEP潜伏期、波幅的差异性,并将术中SEP波幅变化与暴露椎板后的基线进行比对,按波幅降低幅度的大小分为4组：A组（降低＜40％）,B组（降低40％～50％）,C组（降低50％～60％）和D组（降低＞60％以上）,记录各组患者术后的神经功能状况.结果 麻醉后和暴露后的SEP波形差异有统计学意义（P＜0.01）,暴露后的潜伏期较麻醉后延长（3.28±1.72）ms（左下肢）和（3.30±2.09） ms（右下肢）,暴露后的波幅较麻醉后降低0.17（0.39）μV（左下肢）和0.19（0.40） μV（右下肢）;C、D组患者术后神经功能损害差异有统计学意义（P＜0.05）.结论 脊柱侧凸手术术中SEP监护以暴露后的SEP波形作为基线可提高SEP监护的准确性.术中若以波幅降低超过50％作为报警标准过于敏感,以波幅降低超过60％作为报警标准方可降低报警的假阳性率.Objective To explore the choice of timing for baseline and alert levels of somatosensory evoked potential （SEP） monitoring during scoliosis surgery.Methods From March 2011 to December 2014,a total of 113 patients with kyphoscoliosis deformity were monitored intraoperatively by SEP.There were 52 males and 61 females with a mean age of （20 ± 15） years.All the patients were recorded preoperativeandintraoperative SEPs on double lower limbs.Latency and amplitude of SEPs were recorded after anesthesia and vertebral laminae exposure respectively and compared with each other.Intraoperative SEPs were compared to baseline as SEP after exposure and divided into 4 groups of A （〈40%）,B（40%-50%）,C （50%-60%） and D （〉 60%） according to the reduced amplitude.Nerve functions were recorded during follow-ups.Results Significant statistical difference existed between SEPs post-anesthesia and SEPs after vertebral laminae exposure （P 〈0.01）.Compared with SEP post-anesthesia,the latency of SEP after exposure was prolonged with （3.28 ± 1.72） ms （left lower limb） and （3.30 ± 2.09） ms （right lower limb） and amplitude decreased with 0.17 （0.39） μV （left lower limb） and 0.19 （0.40） μV （right lower limb）.There was a positive relationship of impaired nerve function between groups C and D （P 〈 0.05）.Conclusion Adopting SEP waveform after exposure as a baseline can improve the accuracy of SEP monitoring during scoliosis surgery.Intraoperative alarm with a reduced amplitude over 50% as the standard may be too sensitive.Alert with a reduced amplitude of over 60% reduces the false positive rate of alarm.

关 键 词：脊柱侧凸 皮层体感诱发电位 监护 基线 报警 

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