多模式电生理监测在颈椎手术中的应用  

Application of multimodal intraoperative neurophysiological monitoring in cervical spine surgery

作　　者：廉海平[1] 张文瑞 高巍[2] 何百祥[1] LIAN Haiping;ZHANG Wenrui;GAO Wei;HE Baixiang(Department of Neurosurgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Anesthesiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China)

机构地区：[1]西安交通大学第一附属医院神经外科,陕西西安710061 [2]西安交通大学第一附属医院麻醉科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2021年第3期367-374,共8页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省创新人才推进计划—青年科技新星项目(No.2019KJXX-046);国家自然科学基金面上项目(No.81771485,No.81971290);陕西省重点研发计划项目(No.2020SF-136);校级中央高校基本科研业务费(No.xjj2018262)。

摘　　要：目的探讨多模式电生理监测技术在颈椎手术中的应用。方法回顾性收集2018年1月至2019年12月在本院神经外科接受颈椎手术的患者资料,所有患者在脑电双频指数(BIS)指导下控制麻醉深度,颈椎高位病变采用体感诱发电位(SEP)、运动诱发电位(MEP)、脑干听觉诱发电位(BAEP)和肌电图(EMG)监测;颈椎低位神经脊髓损伤采用SEP、MEP和EMG联合监测,记录并总结术中电生理监测异常、术后离院时及术后6个月手术疗效及并发症情况。结果112例患者术中BIS参数为45~60,MEP波幅下降9例(8.0%),SEP波幅下降4例(3.6%),EMG波幅异常5例(4.5%),BAEP波幅下降4例(3.6%),没有因监测显著异常而终止手术。112例患者术毕较术前比较,44例(39.3%)SEP、MEP波幅变化不大,35例(31.3%)SEP波幅轻度上升,2例(1.8%)轻度下降;24例(21.4%)MEP波幅轻度升高,7例(6.3%)轻度下降。术后离院时及术后6个月未出现新的神经障碍。结论多模式电生理监测在术后即刻表现出受损神经的电生理活动恢复情况,为神经功能恢复提供客观依据,同时可有效预防和降低医源性脊髓和神经功能损伤,提高手术疗效。Objective To explore the application of multi-mode electrophysiological monitoring technology in cervical spine surgery.Methods We retrospectively collected data of patients who received cervical spine surgery in Department of Neurosurgery of our hospital in January 2018 to December 2019.All patients were guided by the bispectral index(BIS)to control the depth of anesthesia.High cervical spine lesions were treated with somatosensory evoked potentials(SEP),motor evoked potentials(MEP),brainstem auditory evoked potentials(BAEP)and electromyography(EMG)monitoring.We selected SEP,MEP and EMG combined monitoring for low cervical nerve and spinal cord injury,recorded and summarized the abnormalities of intraoperative electrophysiological monitoring,surgical efficacy and complications at the time of discharge and 6 months after surgery.Results The intraoperative BIS parameters of 112 patients were 45-60,the MEP amplitude decreased in 9 cases(8.0%),the SEP amplitude decreased in 4 cases(3.6%),the EMG amplitude was abnormal in 5 cases(4.5%),and the BAEP amplitude decreased in 4 cases(3.6%);no operation was terminated due to significant abnormalities in monitoring.Compared with 44 cases(39.3%)before operation,112 patients had little change in SEP and MEP amplitudes,35 cases(31.3%)had a slight increase in SEP amplitude,2 cases(1.8%)had a slight decrease,24 cases(21.4%)had slightly increased MEP amplitude,while 7 cases(6.3%)had slightly decreased one.There were no new neurological disorders at the time of postoperative discharge and 6 months after surgery.Conclusion Multi-mode electrophysiological monitoring shows the recovery of damaged nerve electrophysiological activity immediately after the operation,which provides an objective basis for the recovery of nerve function,and can effectively prevent and reduce iatrogenic spinal cord and nerve function damage,and improve the efficacy of surgery.

关 键 词：颈椎手术 脑干听觉诱发电位 运动诱发电位 体感诱发电位 肌电图 脑电双频指数 

分 类 号：R744[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]