术中皮质躯体感觉诱发电位监测对脊髓功能及预后判定的价值

The value of CSEP intraoperative monitoring in evaluating spinal cord function and predicting prognosis

目的探讨术中皮质躯体感觉诱发电位（CSEP）监测对客观评价脊髓功能及完整性并判断神经功能预后的价值。方法对56例脊柱脊髓手术患者，实施手术前、中、后CSEP监测，观察并分析其潜伏期及波幅，波幅降低≥50％或潜伏期延长≥10％为明显改变，即报警标准。结果真阴性71．43％（40／56），术中潜伏期及波幅均无异常变化，术后无新的神经功能障碍；假阴性1．79％（1／56），术中CSEP无明显变化，但术后患者出现新的神经功能障碍；真阳性26．79％（15／56），手术过程中CSEP出现短暂潜伏期延长〈10％、波幅下降〈50％，暂停操作或改变操作方向后波形恢复或改善。结论在脊柱手术中，CSEP对脊髓的牵拉、缺血以及损伤很敏感，术中及时干预，可使CSEP恢复或改善；CSEP能较好地反映脊髓功能及完整性，对防止术中脊髓损伤、判定神经功能预后有重要价值。

Objective To explore the value of somatosensory cortex evoked potential （CSEP） monitoring in objective evaluation of spinal cord function and integrity as well as prognostication of neural function after surgery. Methods CSEP monitoring was performed before the operation, during surgical procedure and after the operation in 56 spinal cord surgery patients to observe and analyze latency and amplitude of cortical potential. The significant changes were amplitude reduction ≥50% or latency prolongation ≥10%. Results There were 71.43% （40/56） true negative finding, both latency and amplitude without abnormal changes during the operation and without new neural functional deficit after operation. There was 0.18% （1/56） false negative finding, latency and amplitude without abnormal changes during surgical procedure, but with new neural functional deficit after operation. There were 26.79% （15/56） true positive findings, where latency transient prolongation 〈 10% and amplitude reduction 〈 50% during surgical procedure were observed. After suspending procedure or changing direction during surgical procedure, the waveform restored or improved. Conclusion CSEP monitoring during surgical procedure could reflect the sensitiveness to distracting, isehemia and injury of spinal cord. A timely intervention might improve the CSEP. CSEP could reflect the function and integrity of spinal cord. CSEP possess an important value in preventing spinal cord injury and evaluating the prognosis of neural function.