全麻下脊柱脊髓手术中神经电生理监测异常的原因分析

Analysis of Abnormalities of Intraoperative Neurophysiological Monitoring in Spine and Spinal Cord Surgery under General Anesthesia

目的分析全麻下脊柱手术中影响神经电生理监测的因素,提高监测有效性。方法对2011年7月至2016年1月在本院全麻下接受脊柱脊髓手术中实施体感诱发电位(SEP)及运动诱发电位(MEP)监测的患者资料进行回顾性分析。结果收集到104例患者资料,其中18例出现SEP异常,17例出现MEP异常。单因素分析显示,SEP与吸入麻醉药浓度、围术期低体温、麻醉方式有关(χ~2>6.219,P<0.05),而MEP异常与吸入麻醉药浓度、围术期低血压、追加肌松剂有关(χ~2>4.125,P<0.05)。多因素非条件Logistic分析显示,吸入麻醉药浓度、围术期低体温对SEP异常有显著性影响(P<0.05),而吸入麻醉药浓度、围术期低血压对MEP异常有显著性影响(P<0.05)。结论吸入麻醉药浓度、围术期低体温、围术期低血压可能是影响神经电生理监测的主要因素。

Objective To analyze the factors related with intraoperative neurophysiological monitoring （IONM） in spine and spinal cord surgery under general anesthesia, in order to increase the effectiveness of IONM. Methods A retrospective study was performed on patients who received somatosensory-evoked potential （SEP） and motor-evoked potentials （MEP） in spine surgery under general anesthesia from July, 2011 to January, 2016. Results Data from 104 patients were collected in which 18 cases had abnormal SEP and 17 cases had abnormal MEP. A single factor analysis indicated that abnormal SEP was related to concentration of inhalation anesthetic （CIA）, hypothermia in peri- operative period （HTM）, and type of anesthesia （x2〉6.219, P〈0.05）, whereas abnormal MEP was related to CIA, hypotension in periopera- tive period （HTN）, and additional muscular relaxants （x2〉4.125, P〈0.05）. Logistic regression analysis indicated that abnormal SEP was relat- ed to CIA and HTM, whereas abnormal MEP was related to CIA and HTN （P〈0.05）. Conclusion C/A, HTM, and HTN were possible fac- tors related with IONM in spine surgery under general anesthesia.