Recently, many surgeons have been using intraoperative neurophysiological monitoring(IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, caud...Recently, many surgeons have been using intraoperative neurophysiological monitoring(IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials(MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome.展开更多
目的比较不同肌松水平[4个成串刺激(train of four stimulation,TOF)的T1分别为5%~15%基础值和45%~55%基础值水平]对脊柱手术中脊髓神经电生理监测结果的影响,探讨安全有效的电生理监测麻醉方案。方法选择行术中脊髓神经电生理监测的择...目的比较不同肌松水平[4个成串刺激(train of four stimulation,TOF)的T1分别为5%~15%基础值和45%~55%基础值水平]对脊柱手术中脊髓神经电生理监测结果的影响,探讨安全有效的电生理监测麻醉方案。方法选择行术中脊髓神经电生理监测的择期脊柱手术病人23例。采用丙泊酚和瑞芬太尼全凭静脉麻醉,阿曲库铵维持肌松,监测拇内收肌TOF指示肌松水平,监测体感诱发电位(somatosensory evoked potentials,SEP)和运动诱发电位(motor evoked potentials,MEP)评判脊髓功能。分别记录神经肌肉阻滞水平1(neuromuscular blockade level 1,NMB_1)(T1为5%~15%基础值)和NMB_2水平(T1为45%~55%基础值)时SEP和MEP的波幅和潜伏期,同时记录经颅电刺激时病人是否出现剧烈体动和自主呼吸。结果不同肌松水平的SEP波幅和潜伏期之间差异均无统计学意义(P>0.05)。同一监测部位不同肌松水平的MEP潜伏期差异无统计学意义(P>0.05),左上肢和右下肢不同肌松水平的MEP波幅则差异有统计学意义(P<0.05)。NMB2水平时的经颅电刺激时剧烈体动发生率明显高于NMB1水平时(P<0.05)。两个肌松水平经颅电刺激时均无自主呼吸产生。结论肌松剂的使用在行神经电生理监测的脊柱手术中并非完全禁忌,TOF的T1在45%~55%基础值的肌松水平可能是高风险脊髓手术较理想的肌松水平。展开更多
目的初步探讨神经电生理监测技术在椎管内疾病手术中的临床应用价值。方法回顾性分析30例椎管内疾病病人的临床资料。术前Frankel分级:C级4例,D级16例,E级10例。术中应用皮质体感诱发电位(CSEP)与肌电图(EMG)监测脊髓和神经根功能,分析...目的初步探讨神经电生理监测技术在椎管内疾病手术中的临床应用价值。方法回顾性分析30例椎管内疾病病人的临床资料。术前Frankel分级:C级4例,D级16例,E级10例。术中应用皮质体感诱发电位(CSEP)与肌电图(EMG)监测脊髓和神经根功能,分析手术过程并评价其效果。结果肿瘤全切10例,次全切13例,大部切除2例,部分切除2例;另有脊髓栓系综合征3例,术中完全松解黏连病变。术后10 d Frankel分级:改善6例,无变化22例,加重2例;术后1年Frankel分级:改善14例,无变化15例,加重1例。术前Frankel分级3组病人进行比较,术后10 d和1年的疗效差异均无统计学意义(均P>0.05)。结论在椎管内手术中联合应用CSEP与EMG监测可以更好地保护脊髓和神经根功能。展开更多
目的:探讨脊柱外科手术中体感诱发电位监护技术的准确性。方法:对78例颈、胸椎手术患者术中采用皮层体感诱发电位(cortical som atosensory evoked potential,CSEP)术中监测,记录术前、术中、术后各个重要手术步骤的CSEP变化,根据不同...目的:探讨脊柱外科手术中体感诱发电位监护技术的准确性。方法:对78例颈、胸椎手术患者术中采用皮层体感诱发电位(cortical som atosensory evoked potential,CSEP)术中监测,记录术前、术中、术后各个重要手术步骤的CSEP变化,根据不同阶段诱发电位的变化与术后临床脊髓功能改变相结合,判断CSEP的准确性。结果:78例患者中,CSEP未达到监护界值71例,术后无脊髓损伤;5例患者术中CSEP达到预警标准,告诫手术医生,注意手术操作,术后无脊髓损伤;另外,出现假阳性和假阴性各1例,术后恢复亦良好。结论:排除各种干扰因素后体感诱发电位可较准确地对脊髓的功能状况进行监测,是较准确的脊柱外科手术监护技术。展开更多
文摘Recently, many surgeons have been using intraoperative neurophysiological monitoring(IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials(MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome.
文摘目的初步探讨神经电生理监测技术在椎管内疾病手术中的临床应用价值。方法回顾性分析30例椎管内疾病病人的临床资料。术前Frankel分级:C级4例,D级16例,E级10例。术中应用皮质体感诱发电位(CSEP)与肌电图(EMG)监测脊髓和神经根功能,分析手术过程并评价其效果。结果肿瘤全切10例,次全切13例,大部切除2例,部分切除2例;另有脊髓栓系综合征3例,术中完全松解黏连病变。术后10 d Frankel分级:改善6例,无变化22例,加重2例;术后1年Frankel分级:改善14例,无变化15例,加重1例。术前Frankel分级3组病人进行比较,术后10 d和1年的疗效差异均无统计学意义(均P>0.05)。结论在椎管内手术中联合应用CSEP与EMG监测可以更好地保护脊髓和神经根功能。
文摘目的:探讨脊柱外科手术中体感诱发电位监护技术的准确性。方法:对78例颈、胸椎手术患者术中采用皮层体感诱发电位(cortical som atosensory evoked potential,CSEP)术中监测,记录术前、术中、术后各个重要手术步骤的CSEP变化,根据不同阶段诱发电位的变化与术后临床脊髓功能改变相结合,判断CSEP的准确性。结果:78例患者中,CSEP未达到监护界值71例,术后无脊髓损伤;5例患者术中CSEP达到预警标准,告诫手术医生,注意手术操作,术后无脊髓损伤;另外,出现假阳性和假阴性各1例,术后恢复亦良好。结论:排除各种干扰因素后体感诱发电位可较准确地对脊髓的功能状况进行监测,是较准确的脊柱外科手术监护技术。
