脊柱脊髓手术中运动诱发电位波幅消失或下降的原因分析  

Analysis of the causes of the disappearance or decline of motion evoked potential amplitude during spinal column and spinal cord surgery

作　　者：朱玲[1] 王超 宋新苗 刘凤欣 朱琳[1] ZHU Ling;WANG Chao;SONG Xinmiao(Department of Electromyography Anesthesiology,The Third Hospital of Hebei Medical University,Hebei,Shijiazhuang 050051,China;不详)

机构地区：[1]河北医科大学第三医院肌电图科,石家庄市050051 [2]河北医科大学第三医院友谊院区骨二科,石家庄市050051

出　　处：《河北医药》2021年第22期3409-3412,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划(编号:20170134)。

摘　　要：目的探讨脊柱脊髓手术术中在体感诱发波形分化良好的基础下运动诱发电位波幅消失或下降原因,提高术中MEP成功监测率。方法在2017年6月至2018年12月入河北医科大学第三医院行309例脊柱脊髓手术患者中,使用体感诱发电位(somatosensory evoked potential,SEP)、经颅电刺激运动诱发电位(motor evoked potentials,MEP)、自由肌电(free-run electromyography)多模式联合监测,本文入选病例条件在术中体感诱发电位波形分化良好且持续存在至手术结束,仅术中出现运动诱发电位波幅下降或消失,入选病例49例,对MEP波形下降及消失原因进行分析。结果49例患者术中下肢部分被检肌MEP波幅下降或消失25例,部分被检肌MEP波幅下降18例,双下肢被检肌MEP波幅均消失6例。其中,手术结束后MEP波幅恢复44例,MEP波幅始终未见恢复5例,但术后1个月内肌力恢复至1级~2+级。其中因麻醉时间过长至静脉麻醉药物蓄积27例,肌松药使用过量导致MEP波幅下降及消失14例,短暂性瘫痪3例,吸入麻醉药术中加量3例,失血过多和低体温2例。结论脊柱脊髓手术中,对于术中SEP波幅分化良好的患者,出现MEP波幅下降或消失,有多重因素的影响,其中静脉麻醉蓄积作用及肌松药的代谢对其影响最大,神经外科手术中短暂性瘫痪原因比较复杂,与麻醉医师、手术医师共同协作提高手术检测效率,降低神经功能损伤程度。Objective To investigate the the causes of the disappearance or decline of motion evoked potential amplitude during spinal column and spinal cord surgery,so as to improve the successful monitoring rate of intraoperative MEP.Methods A total of 309 patients who underwent spinal column and spinal cord surgery in our hospital from June 2017 to December 2018 were enrolled in the study,who underwent multi-mode combination monitoring of somatosensory evoked potential(SEP),motor evoked potentials(MEP)and free-run electromyography during the operation.The condition of the selected somatosensory evoked potentials was well differentiated and persisted until the end of the operation.And the motion-evoked potential amplitude was decreased or disappeared in 49 patients.The cause of MEP waveform decrease and disappearance was analyzed.Results Of the 49 patients,MEP amplitude was decreased in the lower limbs of 25 pateints,and part MEP amplitude was decreased in 18 patients,and the MEP amplitude in both lower limbs was disappeared in 6 patients.Among the 49 patients,there were 44 cases of MEP amplitude recovery after operation,and MEP amplitude was not recovered in 5 patients,but the muscle strength recovered to level 1 to 2+within 1 month after operation.Moreover 27 cases were caused by excessive anesthesia time and accumulation of intravenous anesthetic drugs,and the MEP amplitude was decreased and disappeared due to excessive use of muscle relaxants in 14 patients,and 3 cases were caused by transient paralysis,and the other 3 cases were caused by the excessive use of inhaled anesthetics and 2 cases were caused by excessive blood loss and hypothermia.Conclusion During spinal column and spinal cord surgery,the MEP amplitude decreases or disappears in patients with good SEP amplitude differentiation.There are multiple factors,of which,the accumulation of intravenous anesthesia and the metabolism of muscle relaxants have the most important effects on neurosurgery.The causes of transient paralysis are more complicated,and anesthes

关 键 词：脊柱脊髓手术 体感诱发电位 运动诱发电位 静脉麻醉蓄积 短暂性瘫痪 

分 类 号：R337.5[医药卫生—人体生理学]