颅脑动脉瘤夹闭术中体感诱发电位新预警标准缺血耐受比对术后脑缺血的预测价值

Brain aneurysm intraoperative somatosensory evoked potential new warning criteria( ischemic tolerance ratio) of predictive value for postoperative cerebral ischemia

目的探讨颅脑动脉瘤夹闭术中体感诱发电位(SEP)新预警标准缺血耐受比对术后脑缺血的预测价值。方法将2012年3月至2014年9月行颅脑动脉瘤夹闭术的60例患者随机分为A、B、C三组,进行电位监测,各组缺血耐受比值依次为0、50%、80%。详细记录各患者开始、SEP预警、终止临时阻断之间消耗时间及术中术后的相关症状及事件。结果比较60例患者一般资料对比差异均无统计学意义(P>0.05);三组患者开始到SEP预警时间无显著性差异(P>0.05),但预警到阻断解除的时间、阻断的总时间对比差异有统计学意义(P<0.05);缺血耐受比0的灵敏度和特异度较低,耐受比为50%、80%的灵敏度和特异度较高,但80%组的研究对象多发生术后脑缺血。结论缺血耐受比能反映患者术中体感诱发电位与术后患者神经功能缺损的联系,能很好预测与指导临床阻断。且优于目前公认的SEP预警标准(50%波幅下降),宜选用缺血耐受比50%作为预警标准。

Objective To investigate the brain aneurysm intraoperative somatosensory evoked potential new warning criteria（ ischemic tolerance ratio） of predictive value for postoperative cerebral ischemia. Methods Between 2012 March to 2014 September,60 patients received brain aneurysm operation. All 60 patients were randomly divided into A,B,C three groups of somatosensory evoked potential monitoring. The ischemic tolerance ratio of three groups were 0,50%,80%,with records of the patients from temporary blocking to SEP reached the warning standard time,SEP reached the warning standard to termination of temporary blocking time,blocking related symptoms and postoperative events during the operation time. Results The gender,age,Hunt-Hess grade,tumor location and blocking parts of artery of the 60 patients were compared,the differences were not statistically significant（ P〉0. 05）. The difference from the beginning of temporary blocking to SEP reaching the warning standard time is not statistically significant,but the total time to reach the warning standard blocking release time all have significant statistically significant difference（ P〈0. 05）. The ischemic tolerance ratio in the standard 0 group obtained a lower sensitivity and specificity,ischemic tolerance ratio of 50% and 80% for the standard research group obtained high sensitivity and specificity. However,the research object of the 80%groups occurred postoperative cerebral ischemia. Conclusion Ischemia tolerance ratio can reveal objectively the change and intraoperative somatosensory evoked potentials between the patients with neurological deficit after contact. This ratio has good predictive value and guiding significance in the temporary blocking. This ratio is better than the currently accepted SEP warning criteria（ 50% amplitude decreased）,and should choose the ischemic tolerance than 50% as the warning standard.