体感与运动诱发电位用于颈动脉内膜剥脱术中脑缺血监测的比较

The comparison of somatosensory evoked potential and motor evoked potential monitoring for cerebral ischemia during carotid endarterectomy

目的研究颈动脉内膜剥脱术中体感诱发电位（somatosensory evoked potential, SSEP）和运动诱发电位（motorevoked potential,MEP）监测脑缺血与术后神经功能障碍的关系。方法回顾性调查2011年9月-2014年7月在首都医科大学附属北京天坛医院行颈动脉内膜剥脱术（carotid endarterectomy，CEA）患者84例资料。每例患者术中常规监测SSEP和MEP，并记录麻醉前、颈内动脉阻断后以及颈内动脉开放后SSEP和MEP波幅和潜伏期的变化。以术后影像学榆查发现新发脑缺血为诊断标准，评估术后神经功能障碍与术中诱发电位监测变化的相关性。结果SSEP监测成功的患者81例，而MEP监测成功的患者为68例。SSEP监测阳性的患者11例，MEP监测阳性的患者29例。SSEP监测阳性的患者中，有5例术后影像学检查发现手术侧新发脑缺血灶。通过连续校正χ2检验分析，与颈动脉临时阻断前比较，颈动脉开放后对侧上肢和下肢SSEP波幅下降大于50％和／或潜伏期延长大于10％与术后发生神经功能障碍有关（P〈0．05）。但是术中对侧MEP的变化与术后发生神经功能障碍无关。结论SSEP波幅下降50％和／或潜伏期延长大于10％与CEA患者术后神经功能障碍有关。MEP的变化与CEA患者术后发生神经功能障碍的关系不大。

Objective The objective of this retrospective study is to investigate the relationship between the postoperative cerebral ischemia and somatosensol7 evoked potential （SSEP） or motor evoked potential （MEP） monitoring, during carotid endarterectomy. Methods Eighty-four patients undergoing carotid endarterectomy （CEA） undergoing general anesthesia with monitoring of bilateral SSEP and MEP were retrospectively reviewed between September 2011 and July 2014. The rates of successful assessment of SSEP and MEP and changes in SSEP and MEP monitoring were investigated. Postoperative cerebral ischemia assessed by CT and the correlation between the significant changes of intraoperative evoked potential and postoperative neurologieal dysfunction was studied. Results Multimodal SSEP monitoring was achieved in 81 patients, whereas MEP was recorded in 68 cases. Significant SSEP changes occurred in 11 patients and MEP in 29 patients. Five patients showed permanent postoperative neurological deficit. Significant SSEP changes were related with postoperative neurological dysfunction（P〈0.05）. However, the changes of contralateral MEP were not related with neurological dysfunction without statistically significant （P〉0.05）. Conclusions Our data suggest that SSEP were significantly associated with postoperative cerebral isehemia. However, the small number of patients limits the conclusiveness of these findings. MEP monitoring could not prevent a postoperative motor deficit in all patients.