脊柱手术中皮层体感诱发电位基准的选择

Intraoperative spinal cord monitoring during spinal surgery with cortical somatosensory evoked potentials

目的通过对脊柱手术术中皮层体感诱发电位(cortical somatosensory evoked potential,CSEP)监护波形分析,了解其变化规律,制定合理的基准和报警标准,降低监护过程中脊髓损伤预报的假阳性事件,提高脊髓监护的可靠性。方法回顾性分析76例不同类型的脊柱手术术中脊髓监护,将监护期分为预测试期、调整期、重点监护期、报警期,对应基准分别为I期、Ⅱ期、Ⅲ期、Ⅳ期基准,分析诸期的基准特点,由此决定报警标准。按有无神经功能缺陷将76例患者分为A、B两组,对比两组脊髓监护的假阳性率;结果四期基准报警率之间有显著性差异,Ⅳ期基准的报警符合率最高。A与B两组的假阳性率之间有显著性差异,A组假阳性率高于B组;结论术前有神经缺陷较无神经缺陷的脊柱疾患,CSEP假阳性率高,应尽量采用联合监护;报警标准和基准要因时而异、综合分析,不可教条化。

Objective： To diminish the false-positive rates and improve the reliability of monitoring,the characteristic of the cortical somatosensory evoked potentials（CSEP） for intraoperative spinal cord monitoring during spinal surgery.Methods： Seventy-SIX patients undergoing intraoperative spinal cord monitoring were collected in this retrospective study.Two distinct groups（A and B groups） of patients were identified from analyzing neurological function preoperatively and the false-positive rates were recorded postoperatively.Four reference baselines according to the different stages of surgery were analysed.Results： There was significant difference between A and B group.The false-positive rates of Group A was higher than that of Group B;The Ⅳ-baseline was more reliable for intraoperative spinal cord monitoring than the others.Conclusion： The false-positive rates of patients with neurological function defect is higher than that without neurological function defect.The study suggests that the standard of monitor alarming and baseline should be varied according to the different stages of surgery.