体感诱发电位动态监测在神经外科手术中保护运动功能的应用  

Application of dynamic somatosensory evoked potential monitoring in the protection of motor nerve during neurosurgical procedures

作　　者：葛玉元[1,2] 贡志刚[3] 蒋佩龙[4] 

机构地区：[1]南京中医药大学附属中西医结合医院神经外科,210028 [2]江苏省中医药研究院 [3]南京中医药大学苏州附属医院神经外科 [4]苏州大学附属第二医院神经外科

出　　处：《临床神经外科杂志》2016年第4期281-284,共4页Journal of Clinical Neurosurgery

基　　金：江苏省"333高层次人才培养工程"基金(BAR2014090)

摘　　要：目的探讨体感诱发电位(SEP)监测技术在神经外科手术中保护运动功能的临床应用价值。方法对54例神经外科患者手术中实时监测SEP,当术中波形发生异常变化时调整手术操作以改善SEP,评估发生各型变化的患者术后运动功能情况。分析对比术中、术毕SEP变化与术后肌力的改变,并应用χ2检验进行统计学分析。结果术中36例患者出现Ⅰ型SEP变化,其中34例患者术后肌力未见明显异常,2例患者肌力较前减退;7例患者出现Ⅱ型SEP变化,术后均未出现运动功能障碍;5例患者出现Ⅲ型SEP变化,术后均出现肌力减退;6例患者出现Ⅳ型SEP变化,术后5例患者出现肢体完全偏瘫。术中术毕SEP无变化组肌力下降率显著低于变化组。结论在神经外科手术中动态监测SEP能实时发现神经功能损伤,便于术者及时采取措施保护神经功能。根据SEP的改变还有助于预测患者术后的运动功能。Objective To evaluate the clinical application of somatosensory evoked potential monitoring in the protection of motor nerve during neurosurgicalprocedures .Methods 54 cases of neurosurgical patients were performed , under the real-time somatosensory evoked potential （ SEP ） monitoring .If SEP waveforms changed significantly , operations were modified or even stopped . Individual motor function corresponding to different intraoperative SEP changes was valuated postoperatively .The changes of SEP and muscle strength after operation were analyzed and compared .Statistical results were analyzed with Chi-square test .Results 36 patients demonstrated TypeⅠSEP waveforms , only 2 of whom had decreased muscle strength .7 patients demonstrated TypeⅡSEP waveforms , and no patients had postoperative motor deficits .5 patients demonstrated TypeⅢSEP waveforms , all of them had postoperative motor deficits .6 patients demonstrated TypeⅣSEP, 5 of whom behaved hemiplegia .The rate of myodynamia deterioration in the group with normal SEPs was significantly lower than that in the group with unrecovered abnormal SEPs . Conclusion During neurosurgical procedures , dynamic monitoring of SEPs can detect real time neurological deficits , which is beneficial for surgeons to timely protect related function .Moreover, SEP changes are helpful to predict postoperative motor function .

关 键 词：体感诱发电位 运动功能 监测 手术中 

分 类 号：R651.1[医药卫生—外科学]