椎板切除减压术中体感诱发电位预测模型的建立  

Establishment of a predictive model for somatosensory evoked potentials during decompression laminectomy

作　　者：汪红亮[1] 周涛[1] 王璐[2] 查本义 周捷 WANG Hongliang;ZHOU Tao;WANG Lu;ZHA Benyi;ZHOU Jie(Ma'anshan People's Hospital,Anhui Medical University Ma'anshan Clinical School,Ma'anshan,Anhui 243000,China;不详)

机构地区：[1]马鞍山市人民医院安徽医科大学马鞍山临床学院,安徽马鞍山243000 [2]安徽工业大学机械工程学院,安徽马鞍山243000

出　　处：《中国临床研究》2024年第5期724-728,734,共6页Chinese Journal of Clinical Research

基　　金：安徽省重点研究与开发项目(202104j07020060)。

摘　　要：目的探讨影响椎板切除减压术中体感诱发电位(SEP)的因素,并建立预测模型。方法回顾性分析2021年1月至2023年1月于马鞍山市人民医院脊柱骨科行椎板切除减压术的120例脊柱椎管狭窄患者的SEP监测资料。根据有无发生SEP信号改变将患者分为SEP改变组(n=21)和对照组(n=91)。采用Lasso回归、交叉验证法、单因素及多因素logistic回归分析确定预测因素。绘制预测SEP改变的列线图,并使用受试者工作特征(ROC)曲线、校准曲线及临床决策曲线来对模型进行评估。结果多因素logistic回归分析显示,超重、出血量、体温、电刀使用情况是影响SEP的独立影响因素,差异有统计学意义(P<0.05)。在模型的验证中,列线图的AUC为0.914,说明模型具有良好的区分度。最优校准曲线显示预测值和实际值具有良好的一致性。临床决策曲线显示模型具有良好的临床实用性。结论超重、出血量、体温、电刀使用情况是SEP变化的影响因素,建立预测SEP变化的列线图,使脊柱科医师能采取有效的预防治疗措施,增加神经电生理监测的准确性。Objective To explore the influencing factors affecting somatosensory evoked potential(SEP)during decompression laminectomy and to establish a prediction model.Methods The SEP monitoring data from 120 patients with spinal stenosis who underwent decompression laminectomy at the Spinal Orthopedics Department of Ma'anshan People's Hospital from January 2021 to January 2023 were analyzed retrospectively.Patients were divided into SEP-altered group(n=21)and control group(n=99)based on the presence or absence of SEP signal alteration.Predictors were determined using Lasso regression,cross-validation,logistic regression analysis.A column-line plot predicting change in SEP based on independent predictors was drawn.Receiver operating characteristic(ROC)curves,calibration curves,and clinical decision curves were used to evaluate the model.Results Logistic regression analysis indicated that overweight,hemorrhage,body temperature,and use of electrosurgical equipment were independent risk factors affecting SEP,with statistically significant differences(P<0.05).In the validation of the model,the AUC of the column-line plot was 0.914,indicating that the model had good discrimination.The optimal calibration curve showed good agreement between predicted and actual values.The clinical decision curve attested to the practical efficacy of the model.Conclusion Factors affecting changes in SEP include overweight,hemorrhage,body temperature,and the use of electrosurgical equipment.The construction of a column chart to forecast SEP changes empowers spinal physicians to implement proactive therapeutic interventions effectively,concurrently enhancing the precision of electrophysiological monitoring.

关 键 词：体感诱发电位 椎板切除减压术 列线图 超重 出血量 体温 神经电生理 

分 类 号：R651.2[医药卫生—外科学]