术中诱发电位监测对胸腹主动脉置换患者术后脊髓损伤的影响

Effect of intraoperative evoked potential monitoring on spinal cord injury in thoracoabdominal aortic aneurysm repair

目的:评价术中诱发电位监测(SEP)能否减少胸腹主动脉置换患者术后脊髓损伤的发生率。方法:回顾性分析安贞医院自2011年7月至2018年1月,择期胸腹主动脉置换术患者204例围术期资料,根据是否使用SEP将患者分为SEP组(n=69)与未监测组(n=135)。结果:10例患者术后发生脊髓损伤,其中SEP组4例,未监测组6例,脊髓损伤发生率为4.9%(10/204)。两组术后脊髓损伤发生率差异无统计学意义(P=0.736)。术中近端胸主动脉阻断期间、肋间动脉阻断期间、术毕体感与运动诱发电位阳性的患者均无人发生术后脊髓损伤。监测组4例术后脊髓损伤患者术中体感与运动诱发电位均为阴性。结论:胸腹主动脉置换术中采用SEP能发现脊髓缺血情况,但其不能降低术后脊髓损伤的发生率。应注意术中诱发电位阴性的患者术后仍有发生脊髓损伤的可能。

Objective:To evaluate the role of intraoperative evoked potential monitoring in decreasing the incidence of spinal cord injury in thoracoabdominal aortic aneurysm repair.Methods:The perioperative data of 204 patients who performed elective thoracoabdominal aortic aneurysm repair from July 2011 to January 2018 were retrospectively analyzed.Patients were divided into evoked potential group(n=69)and control group(n=135)according to whether evoked potential monitoring was used or not.Results:Ten patients occurred spinal cord injury postoperatively,including 4 cases in evoked potential group and 6 in control group,the incidence of spinal cord injury was 4.9%(10/204).There was no difference in the incidence of spinal cord injury between the two groups.None occurred spinal cord injury for patients with positive evoked potential changes during the periods of proximal aortic crossclamp,reimplantation of critical intercostal arterials or at the end of operation.The intraoperative evoked potential changes were negative for the 4 patients with spinal cord injury in the evoked potential group.Conclusions:Although evoked potential monitoring could monitor spinal cord ischemia intraoperatively,it could not decease the incidence of spinal cord injury in thoracoabdominal aortic aneurysm repair.Patients with negative evoked potential changes still had the risk of spinal cord injury.