诱发电位技术在全胸腹主动脉替换术中的应用价值  

Application of evoked potentials monitoring in total thoracoabdominal aorta aneurysm repair

作　　者：段玉印[2] 郑军[1] 潘旭东[1] 朱俊明[1] 刘永民[1] 葛翼鹏[1] 程力剑[1] 孙立忠[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科北京市心肺血管疾病研究所北京市大血管疾病诊疗中心,100029 [2]昆明医科大学第一附属医院心外科

出　　处：《中华医学杂志》2016年第13期1007-1010,共4页National Medical Journal of China

基　　金：国家卫生和计划生育委员会公益性行业科研专项（201402009）;首都医学发展科研基金（2011-2006-05）;北京市科学技术委员会-国家国际科技合作与交流专项（2012DFA31110）

摘　　要：目的评价诱发电位技术在主动脉．髂动脉旁路全胸腹主动脉替换术中对脊髓功能保护的应用价值。方法本研究为前瞻性研究。北京安贞医院2014年6月至2015年4月完成31例主动脉一髂动脉旁路全胸腹主动脉替换术，术中应用诱发电位连续监测脊髓功能。根据术中诱发电位结果和临床结局及术后随访结果，评价诱发电位技术对全胸腹主动脉替换术中脊髓功能保护的价值。本研究通过首都医科大学附属北京安贞医院伦理委员会批准。结果诱发电位在主动脉近端阻断后消失，运动诱发电位消失（55．6±18．1）min，体感诱发电位消失（50．3±18．7）min；诱发电位在脊髓节段动脉重建后逐渐恢复。手术结束时所有病例的诱发电位均恢复正常。有2例体感诱发电位始终无变化（假阴性），术后死亡1例，无脊髓缺血损伤发生。术后平均随访10（5～14）个月，无迟发性脊髓损伤发生。结论主动脉一髂动脉旁路全胸腹主动脉替换术中，诱发电位可连续监测脊髓功能，指导术中积极采取脊髓保护措施，预防脊髓缺血相关并发症发生。Objective To evaluate the application value of evoked potentials （EP） monitoring in patients undergoing aorta-iliac bypass for total thoracoabdominal aorta aneurysm repair （tTAAAR） . Methods A prospective study, with a total of 31 patients undergoing tTAAAR and intraoperative EP monitoring from June 2014 to April 2015 was carried out. The results of intraoperative evoked potentials, clinical outcomes and follow-up data of patients were collected for further evaluation. Results The EP wave disappeared [ motor evoked potentials for （55. 6 ± 18. 1 ） min, somatosensory evoked potentials for （50. 3 ± 18.7） min] after proximal descending aorta being clamped, and gradually recovered after the segment arteries of spine cord were reconstructed. The EP wave was restored to normal level at the end of operation in all the cases. The somatosensory evoked potentials remained unchanged in 2 cases （false negative）. One case died after operation. No spinal cord injury occurred. The median follow-up after operation was 10 months （5 - 14 months）. There was no delayed neurological deficit. Conclusion EP provided an on-line monitoring of the condition of spinal cord function, which become an intraoperative protocol to avoid the irreversible injury of spinal cord.

关 键 词：诱发电位 监测 手术中 胸腹主动脉替换术 脊髓缺血 

分 类 号：R654.3[医药卫生—外科学]