TES-MEP和CSEP联合应用评价脊柱手术患者脊髓功能的临床价值  

Clinical value of TES-MEP combined with CSEP in the evaluation of spinal cord function in patients undergoing spinal surgery

作　　者：邓必权[1] 滕宇[1] 胡华[1] 江红辉[1] 张依北 李舰[1] 张卫国[1] 

机构地区：[1]华中科技大学同济医学院附属武汉中心医院脊柱外科,湖北武汉430014

出　　处：《东南大学学报（医学版）》2017年第3期399-403,共5页Journal of Southeast University(Medical Science Edition)

基　　金：湖北省自然科学基金资助项目(2014CFB459)

摘　　要：目的:探讨联合应用皮层体感诱发电位(CSEP)、经颅电刺激运动诱发电位(TES-MEP)监测在脊柱外科手术中的临床价值。方法:对186例脊柱外科手术患者进行回顾性分析,所有患者在脊柱手术中同时接受足拇短屈肌TES-MEP、双侧胫前肌及CSEP监测,对比TES-MEP及CSEP监测结果与术后脊髓感觉与运动功能检测结果的差异,计算其诊断学效能指标。结果:TES-MEP术中监测运动功能阳性的灵敏度为100.00%、特异度为98.09%,监测感觉功能阳性的灵敏度为79.31%、特异度为94.27%;CSEP术中监测运动功能阳性的灵敏度为86.21%、特异度为96.82%,监测感觉功能阳性的灵敏度为93.10%、特异度为98.09%;TESMEP联合CSEP术中监测运动功能和感觉功能阳性的灵敏度均为100.00%、特异度均为99.36%。结论:脊柱外科手术中联合应用CSEP、TES-MEP能够提高脊髓运动功能、感觉功能阳性的监测水平。Objective： To investigate the clinical value of combined application of cortical somatosensory evoked potential（CSEP） and transcranial electrical stimulation motor evoked potentials（TES-MEP） monitoring in spinal surgery.Methods： Retrospective analysis of 186 cases of surgical patients was conducted and all the patients received foot hallux brevis TES-MEP, bilateral anterior tibial muscle and CSEP monitoring in spinal surgery.The difference between the TES-MEP and CSEP monitoring results and the postoperative spinal cord sensory and motor functions was compared,and the diagnosis efficiency index was calculated.Results： The sensitivity and specificity of monitoring motor function in TES-MEP were 100% and 98.09%.The sensitivity of monitoring sensory function in TES-MEP was 79.31%, and the specificity was 94.27%;the sensitivity and specificity of monitoring motor function in CSEP were 86.21% and 96.82%, respectively.The sensitivity of monitoring sensory function in CSEP was 93.10%, and the specificity was 98.09%.The sensitivity and specificity of monitoring motor function and sensory function were 100% and 99.36% in TES-MEP＋CSEP.Conclusion： Combined application of CSEP and TES-MEP in spinal surgery can improve the monitoring level of motor function and sensory function of spinal cord.

关 键 词：脊柱外科 皮层体感诱发电位 经颅电刺激运动诱发电位 监测 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R651.23[医药卫生—临床医学]