电生理指标联合应用在颅内巨大动脉瘤手术中的作用

The combined application of electrophysiological indexes in intracranial giant aneurysm surgery

目的研究躯体感觉诱发电位(SEP)、脑电图、脑干听觉诱发电位(BAEP)联合应用在颅内巨大动脉瘤手术治疗中的影响及临床意义。方法分别对23例颅内巨大动脉瘤患者进行手术直接夹闭或动脉瘤孤立加旁路移植手术,同时行SEP、脑电图和BAEP实时监测,观察手术操作对其的影响。结果 23例患者行颅内巨大动脉瘤手术操作时,均不同程度引起SEP、脑电图和BAEP的变化。其中SEP的N20、P25潜伏期延长3～5 ms,波幅较术前降低50%;BAEP的Ⅰ、Ⅲ、Ⅴ波潜伏期延长0.7～1.0 ms,Ⅰ～Ⅲ、Ⅲ～Ⅴ波峰间期及Ⅰ、Ⅴ波幅电位较术前降低30%～50%以上。结论术中动态监测SEP、脑电图和BAEP的电位变化,可以提示颈动脉阻断后的脑灌注状态,对调整手术时间及手术方式具有重要的指导意义。

Objective To study the contribution and clinical significance of combined application of electrophysiological indexes such as somatosensory evoked potential（SEP）, EEG and brain stem auditory evoked potential（BAEP） in intracranial giant aneurysm surgery. Methods Twenty-three patients with intracranial giant aneurysm were treated with direct clipping or trapping and bypass surgery with real time monitoring of SEP,EEG and BAEP to observe influeuce of surgery on the electrophysiological indexes. Results Among surgical operations in the 23 patients,direct clipping of aneurysm was performed in 5 patients,bypass in 15 patients,and pure trapping in 3 patients. The operations caused SEP, EEG, BAEP changes to some degrees in all cases. The changes included that the latency of N20 and P25 of SEP was prolonged by 3-5 ms and the amplitude lowered by 50% ;the latency of Ⅰ , Ⅲ and Ⅴ waves of BAEP was prolonged by 0.7-1.0 ms and Ⅰ - Ⅲ, Ⅲ -- Ⅴ wave spike intervals and Ⅰ , Ⅴ wave amplitude potential lowered by 30%-50%. Conclusions Intra-operative dynamic monitoring of potential change in SEP,EEG and BAEP can hint brain perfusion state after carotid artery blockage,which has important guidance significance in adjusting operation time and operation procedure.