TCD联合SEPMEP监测在重度颈动脉狭窄患者CEA术中的应用  

Application of TCD combined with SEP and MEP monitoring in CEA for severe carotid artery stenosis

作　　者：李俊青 刘俊英 王冰丹 彭红兵 白敬淼 李利华 李华 LI Junqing;LIU Junying;WANG Bingdan;PENG Hongbing;BAI Jingmiao;LI Lihua;LI Hua(The Third Hospital Xingtai,Xingtai 054000,China;Xingtai People’s Hospital,Xingtai 054000,China)

机构地区：[1]邢台市第三医院,河北邢台054000 [2]邢台市人民医院,河北邢台054000

出　　处：《中国实用神经疾病杂志》2023年第11期1409-1414,共6页Chinese Journal of Practical Nervous Diseases

基　　金：邢台市重点研发计划自筹项目(编号:2021ZC102)。

摘　　要：目的探究重度颈动脉狭窄患者颈动脉内膜切除术(CEA)术中采用经颅多普勒超声(TCD)联合体感诱发电位(SEP)、运动诱发电位(MEP)监测的价值。方法选取2021-02—2023-03邢台市第三医院收治的190例重度颈动脉狭窄患者作为研究对象,所有患者均行CEA,术中采用TCD联合SEP、MEP监测,TCD检查手术部位大脑中动脉(MCA)、平均血流速度(Vm)变化,并记录同时段SEP、MEP波幅变化,以TCD作为金标准,探究SEP、MEP对于重度颈动脉狭窄的预测价值。结果术中颈动脉阻断后,32例(16.84%)MCA下降>50%,其19例N20波幅下降>50%,13例N20波幅下降≤50%,以TCD为金标准,SEP波幅下降预测的敏感度、特异度、准确率、阳性及阴性预测值、Kappa为59.38%、91.77%、86.32%、59.38%、91.77%、0.511;32例患者中22例SEP潜伏期延长>10%,10例SEP潜伏期延长≤10%,SEP潜伏期延长预测的敏感度、特异度、准确率、阳性及阴性预测值、Kappa为68.75%、93.67%、98.47%、68.75%、93.67%、0.624;阻断后2 min术侧SEP波幅下降及潜伏期延长幅度均大于手术对侧(P<0.05);32例患者中9例MEP振幅降低50%,MEP振幅下降预测的敏感度、特异度、准确率、阳性及阴性预测值、Kappa为28.13%、58.44%、75.79%、28.13%、85.44%、0.136;阻断后2 min术侧MEP振幅降低幅度大于手术对侧(P<0.05)。结论SEP、MEP可对重度颈动脉狭窄患者进行连续、有效且无创的监测,SEP波幅下降与潜伏期延长与TCD监测具有良好的一致性,临床可将SEP、MEP与TCD联合对重度颈动脉狭窄行CEA的患者进行监测。Objective To investigate the value of TCD combined with SEP and MEP monitoring in CEA for severe carotid artery stenosis.Methods A total of 190 patients with severe carotid artery stenosis who were admitted to Xingtai Third Hospital from February 2021 to March 2023 were selected as the study subjects.All patients underwent CEA.TCD combined with SEP and MEP monitoring was performed during the operation.TCD was used to observe the changes in mean blood flow velocity(Vm)of middle cerebral artery(MCA)at the surgical site.The amplitude changes of SEP and MEP were recorded.TCD was taken as the golden standard to investigate the predictive value of SEP and MEP for severe carotid artery stenosis.Results After intraoperative carotid artery occlusion,MCA decreased by more than 50%in 32(16.84%)cases,including N20 amplitude decreasing by more than 50%in 19 cases,and N20 amplitude decreasing by 50%or lower in 13 cases.With TCD as the golden standard,the six evaluation indicators(sensitivity,specificity,accuracy rate,positive and negative predictive values,and Kappa value)of the decreased amplitude of SEP for predicting were 59.38%,91.77%,86.32%,59.38%,91.77%and 0.511,respectively.Among the 32 patients,there were 22 patients with SEP latency increasing by more than 10%,and 10 patients with SEP latency increasing by 10%or lower.The six evaluation indicators of increased SEP latency for predicting were 68.75%,93.67%,98.47%,68.75%,93.67%and 0.624,respectively.The decrease in amplitude and increase in latency of SEP on the surgical side were greater than those on the contralateral side at 2-minute after occlusion(P<0.05).Among the 32 patients,there were 9 patients with MEP amplitude decreasing by 50%.The six evaluation indicators of decreased MEP amplitude for predicting were 28.13%,58.44%,75.79%,28.13%,85.44%and 0.136,respectively.The decrease in MEP amplitude on the surgical side was greater than that on the contralateral side at 2-minute after occlusion(P<0.05).Conclusion SEP and MEP can realize continuous,effective and non-inv

关 键 词：颈动脉狭窄 颈动脉内膜切除术 体感诱发电位 经颅多普勒超声 

分 类 号：R743[医药卫生—神经病学与精神病学]