SEP联合TES-MEP监测对脊柱手术患者手术成功率和安全性的影响  

Effects of SEP and TES-MEP on the operation success rate and safety of patients with spinal surgery

作　　者：饶珊珊 徐爽 尚辉[1] RAO Shanshan;XU Shuang;SHANG Hui(Department of Spinal Surgery,Taihe Hospital of Shiyan,Shiyan Hubei 442000,China)

机构地区：[1]十堰市太和医院脊柱外科,湖北十堰442000

出　　处：《局解手术学杂志》2018年第3期196-199,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：卫生部医药卫生科技发展研究课题(W2014ZT292)

摘　　要：目的探讨脊柱手术中经颅电刺激运动诱发电位(TES-MEP)和体感诱发电位(SEP)联合监测手术的成功率和安全性。方法选择2015年12月至2016年12月在我院进行脊柱手术的患者98例,根据术中监护方法分为观察组和对照组,每组49例。观察组术中采用SEP联合TES-MEP监测,对照组术中仅采用SEP监测。术中所有患者采用全静脉麻醉维持,持续观察并记录SEP及TES-MEP的波幅和潜伏期变化。将2组患者术中监测的结果及其与术后脊髓运动和感觉功能的符合情况和并发症发生情况进行比较和分析。结果术中观察组和对照组监测的成功检出率分别为100%和91.84%,差异有统计学意义(P<0.05);术中观察组判断脊髓运动功能的灵敏度、特异性和约登指数均明显高于对照组,差异有统计学意义(P<0.05);术中观察组判断感觉功能的灵敏度、特异性和约登指数均高于对照组,差异有统计学意义(P<0.05)。患者术后的并发症发生率,2组患者差异无统计学意义(P>0.05)。结论 SEP和TES-MEP联合监测脊柱手术中脊柱功能变化的灵敏度和特异性均高于单一使用SEP监测,能准确反映手术中脊柱的功能状态,为手术的进行提供了较好的参考。Objective To investigate the success rate and safety of transcranial electrical stimulation motor evoked potentials(TES-MEP)and somatosensory evoked potential(SEP)in the monitor of the spinal operation.Methods A total of 98 patients with spinal surgery in our hospital from December 2015 to December 2016 were selected and divided into observation group and control group according to the intraoperative monitoring method,49 cases in each group.SEP conbined with TES-MEP were used in the observation group,and SEP monitoring was used in the control group.Intravenous anesthesia was used in all patients to observe and record the amplitude and latency of SEP and TES-MEP.The results of the two groups were compared with those of the postoperative spinal motor and sensory function and the complications.Results The successful detection rate of the observation group and the control group were respectively 100%and 91.84%,and the difference was statistically significant(P<0.05).The sensitivity,specificity and Youden index of the spinal cord movement were significantly higher in the observation group than those in the control group,the difference was not significant(P>0.05).In addition,the sensitivity,specificity and Youden index of the sensory function were higher than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in postoperation complication between the two groups(P>0.05).Conclusion SEP combined with TES-MEP in monitoring function changes of the spine during spinal surgery on sensitivity and specificity are higher than the SEP monitoring,which can accurately reflect the function of the spine in the operation state,and provide a good reference for surgery.

关 键 词：体感诱发电位 经颅电刺激运动诱发电位 脊柱手术 术中监测 脊柱功能 

分 类 号：R615[医药卫生—外科学]