体感诱发电位结合脑电双频指数监测在脊柱矫形术中的应用

Monitoring of somatosensory evoked potentials and bispectral index in spinal column orthopaetic operation

目的 在全凭静脉麻醉下行脊柱矫形术中 ,监测体感诱发电位 (SEP)预防手术操作对脊神经系统的损伤 ,并结合脑电双频指数 (BIS)监测麻醉深度。方法 6 0例脊柱侧凸病人 ,术前均无神经系统损伤症状 ,诱导插管后以静脉复合用药维持全麻。在麻醉前及术中可能损伤神经的操作时段分别监测并记录SEP ,以P40或N5 0波幅下降 >5 0 %和潜伏期延长 10 %为脊神经损伤的阳性标志 ,术中BIS持续监测以观察麻醉深度。结果 全组病人在SEP监测下完成手术 ,术后均无神经系统并发症。麻醉中BIS值控制在 6 0以下 ,无术中知晓。结论 术中SEP监测可完全替代“唤醒试验” ,防止脊神经系统损伤。全凭静脉麻醉可基本消除麻醉药物对SEP的影响。

Objective To evaluate the usefulness of somatosensory evoked potentials (SEP) combined with bispectral index (BIS) to monitor the depth of anesthesia during spinal column orthopaetic operation to protect the spinal cord injury from surgery.Methods 60 cases of scoliosis without any neurological complication under total intravenous anesthesia were studied.SEP was monitored during the procedures,at which a neurological injury is possible.The wave width of P40 or N50 declining more than 50% and the latency prolonging more than 10% were taken as the positive signal of neurological injury.BIS was monitored to reflex the depth of anesthesia throughout the operation.Results All of the patients had no neurological complication after operation under SEP monitoring.BIS was controlled under 60 during all the operations with no awareness.Conclusion Monitoring of SEP can replace recall test to prevent neurological injuries during spinal column orthopaetic operations.Effect of anesthesia drugs on SEP could be eliminated by total intravenous anesthesia.