两种体感诱发电位联合应用组合不同记录点监测预防脊柱矫形术中牵张性脊髓损伤的发生(英文)

Combined application of two somatosensory evoked potential techniques at various recording point for monitoring the onset of stretch spinal injury during rhachial orthomorphia

背景:皮层体感诱发电位易受麻醉药物的影响,需组合受麻醉药物影响小的皮层下体感诱发电位监测脊柱矫形手术以增加监测的准确率。目的:观察采用皮层及皮层下记录点组合应用的体感诱发电位术中监测脊柱矫形手术的优点。设计:两种诱发电位组合应用的验证性观察。单位:中山大学第二附属医院骨科。对象:选择1997-07/2001-12中山大学孙逸仙纪念医院骨科收治的应用皮层及皮层下记录点组合监测脊柱矫形手术患者104例。男40例,女64例,年龄5～19岁。干预:采用美国NICDLET公司生产的VikingIVD诱发电位仪,记录患者麻醉平稳后的皮层诱发电位波形及皮层下诱发电位波形,并分别标记P37及N45,并将其定制为基准线,在术者行固定撑开时观察波幅变化情况。以波幅下降超过50%为阳性。主要观察指标:患者术中皮层及皮层下诱发电位变化。结果:104例患者均进入结果分析。皮层体感诱发电位阳性者3l例,皮层下体感诱发电位阳性者11例,其中3例与手术操作有关,经过相应处理后恢复正常。皮层记录点的准确率75%,皮层下记录点准确率92.2%,采用皮层及皮层下记录点组合监测的准确率96.7%。结论:皮层体感诱发电位受麻醉影响大,但信号好,容易读取;皮层下体感诱发电位受麻醉影响小,但信号弱。组合不同记录点监测脊柱矫形手术可增加监测结果的可靠性。

BACKROUND： Because the cortical somatosensory evoked potential （CSEP） is easily affected by the anaesthesia drugs, so it needs to be combined with the subcortex somatosensory evoked potential （subcortical SEP） which is less affected by the junk to monitoring the spinal orthomorphia so as to increase the accuracy. OBJECTIVE： To monitor the onset of stretch spinal injury during rhachial orthomorphia with Combined application of subcortical SEP and CSEP. DESIGN： A comparative study of two kinds of evoked potential. SETTING： Department of Orthopaedics of the Second Affiliated Hospital of Sun Yat-sen University. PARTICIPANTS： Totally 104 patients with spinal orthomorphia ,including 40 males and 64 females, aged from 5 to 19 years, were selecled from the Department of Orthopaedics of Sun Yi-xian Hospital of Sun Yat-sen University from July 1997 to December 2001. INTERVENTIONS： A Nicolet Viking Ⅳ （NICDLET Company, USA） with intraopcrative monitoring software was used to Record the wave of subcortical SEP and CSEP. The peak and after-following peak of the median N45 and tibial P37 cortical responses were tagged manually for peak latency and peak-to-peak amplitude measurements. Reduction of more than 50% in SEP amplitude compared with the baselines measurement was defined deterioration. MAIN OUTCOME MEASURES： Changes of CSEP and subcortical SEP during the surgery. RESULTS： Data of all 104 patients was entered the final analysis. Among 104 cases, 31 had positive cortex somatosensory evoked potential, 11 had positive infra-cortex somatosensory evoked potential, meanwhile, 3 cases changed into normal after relative treatment,which was related with operation. Accurate of cortex recorded point was 75%, under cortex 92.2%, and combination of cortex and infra-cortex 96.7%. CONCLUSION： The SEP is easily affected by the anaesthesia drugs, but it has good signals to record, however, the subcortical SEP is the contrary condition. The monitoring by combined application of CSEP and subcortical SEP during the spinal surgery can greatly increase the reliability of result.