脊髓手术患者术中体感诱发电位及肌电图监测对术后脊髓功能状态的预测价值  

Predictive value of intraoperative somatosensory evoked potential and electromyography monitoring on postoperative spinal cord function in patients undergoing spinal cord surgery

作　　者：胡静[1] 李海林 叶明[1] 高觉民[1] 吴颐[1] HU Jing;LI Hailin;YE Ming;GAO Juemin;WU Yi(Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Nanjing 210000,China)

机构地区：[1]南京中医药大学附属江苏省中医院,江苏南京210000

出　　处：《中国实用神经疾病杂志》2025年第4期403-408,共6页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金项目(编号:82172022)。

摘　　要：目的探讨脊髓手术患者术中体感诱发电位(SEP)及肌电图(EMG)监测对术后脊髓功能状态的预测作用。方法选取2022-01—2023-06江苏省中医院收治的脊髓肿瘤患者58例,均行脊髓肿瘤切除术,术中采用SEP及EMG监测,记录SEP潜伏期、波幅以及腓总神经与胫神经的传导速度(NCV)与远端潜伏周期(DL),分析术中监测阳性预测术后脊髓功能的敏感度、特异度。结果58例患者均完成手术,手术时长(3.27±0.52)h,术中出血量(1253.84±564.92)mL。术中监测正常26例,发生SEP报警32例,其中10例波形发生不可逆改变;发生EMG报警28例,均经适当处理后波幅恢复,继续完成手术。以术毕SEP报警波幅仍未恢复者为监测阳性,以术后感觉评定为脊髓功能预后标准,术中监测敏感度60.00%,特异度86.79%,ROC曲线下面积0.734(95%CI:0.469~0.999),P>0.05;以术后肌力评定为脊髓功能预后标准,术中监测敏感度50.00%,特异度86.54%,ROC曲线下面积0.683(95%CI:0.428~0.938),P>0.05;以术后感觉与肌力任一功能为脊髓功能预后标准,术中监测敏感度55.56%,特异度89.80%,ROC曲线下面积0.727(95%CI:0.519~0.934),P<0.05。结论术中SEP及EMG监测可有效预测术后脊髓功能状态,提高脊髓手术的安全性。Objective To investigate the predictive effect of somatosensory evoked potential(SEP)and electromyography(EMG)monitoring on spinal cord function in patients undergoing spinal cord surgery.Methods Fifty-eight patients with spinal cord tumors admitted to Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2022 to June 2023 were selected,all of whom underwent spinal cord tumor resection.Intraoperative SEP and EMG monitoring were used to record the latent period,amplitude,conduction velocity(NCV)of common peroneal nerve and tibial nerve and distal latency period(DL)of SEP.The sensitivity and specificity of positive intraoperative monitoring to predict postoperative spinal cord function were analyzed.Results All the 58 patients completed the operation,the average operation time was(3.27±0.52)h,and the average intraoperative blood loss was(1253.84±564.92)mL.Intraoperative monitoring was normal in 26 cases,SEP alarm occurred in 32 cases,of which 10 cases had irreversible changes in waveform.EMG alarm occurred in 28 cases,all of which recovered after proper treatment and continued to complete the operation.Patients whose SEP alarm amplitude did not recover after surgery were detected as positive,and postoperative sensation was used as the prognosis standard for spinal cord function,the sensitivity of intraoperative monitoring was 60.00%,the specificity was 86.79%,and the area under ROC curve was 0.734(95%CI:0.469-0.999),P>0.05.The postoperative muscle strength was used as the prognostic standard for spinal cord function,the sensitivity of intraoperative monitoring was 50.00%,the specificity was 86.54%,and the area under ROC curve was 0.683(95%CI:0.428-0.938),P>0.05.Any function of postoperative sensation or muscle strength was used as the prognosis criteria for spinal cord function,the sensitivity of intraoperative monitoring was 55.56%,the specificity was 89.80%,and the area under ROC curve was 0.727(95%CI:0.519-0.934),P<0.05.Conclusion Intraoperative SEP and EMG monitoring can effectively predict

关 键 词：脊髓肿瘤 脊髓手术 体感诱发电位 肌电图 神经电生理 脊髓功能 

分 类 号：R739.41[医药卫生—肿瘤]