脊髓及神经根监测技术在脊柱外科手术中的应用.docVIP

脊髓及神经根监测技术在脊柱外科手术中的应用 【摘要】 应用体感诱发电位（somatosensory evoked potential, SEP）行颈、胸椎手术脊髓监护及应用自发肌电图行腰椎手术神经根监护，对2种电生理检查的方法学、准确性及影响因素进行分析。［方法］颈、胸椎手术采用SEP监测，根据不同阶段SEP的变化与术后功能相结合，判断SEP的准确性。腰椎手术采用自发肌电图监测神经根功能，以判断神经根在术中是否受到牵拉、激惹及刺激。并观察手术中SEP及自发肌电图的影响因素，减少监测假阳性及假阴性的发生。［结果］颈、胸椎手术128例病人中，监护未达到预警标准116例，术后无神经症状加重表现。术中SEP变化达到预警标准8例，及时提醒手术医生，暂停手术操作，7例患者SEP波幅渐恢复，术后无神经症状加重。1例患者因SEP波幅降低时间超过10 min未恢复，术后神经症状加重。非手术原因如麻醉、低血压及局部低温对SEP的影响均未达到预警标准。假阴性3例，假阳性1例。腰椎手术40例，12例术中出现肌电反应，及时提醒手术医生，避免过多的刺激及牵拉，术后均未出现神经根损伤症状。［结论］颈、胸椎手术，采用SEP监测，排除各种干扰因素，体感诱发电位可较准确地反应脊髓的生理或病理状况。腰椎手术采用自发性肌电图，在严格控制肌松剂使用下，可准确及时地反应神经根的功能，避免神经根的损伤。 【关键词】 体感诱发电位 脊髓监护 自发肌电图 腰神经根 Abstract：［Objective］To evaluate the accuracy and influenceing factors of somatosensory evoked potential in spinal cord monitoring during cervical and thoracic spinal surgery and intraoperative nerve root monitoring in lumbar surgery. ［Method］The somatosensory evoked potential(SEP) were used during arvical and thoracic spinal surgery and evaluated the accuracy of SEP according to the record of different stages and spinal cord function after surgery. The EMG were used to monitor the nerve root function in lumber operation to estimate whether nerve root being stimulated or tensioned. In addition, affected fators of SEP and EMG during operation were observed.［Result］Of 128 cases of cervical and thoracic surgery,116 cases did not reach the warning standards(amplitude decreasing 50% or diappearing) and showed no postoperative enhancement of symptom of nerve roots injury . 12 cases reached the warning standards intraoperatively and the surgeon were warned to take some steps to finish the operations, only in one case incompletely transient paralysis occurred due to the time of amplitude decreasing of intraoperative SEP more than 10 minutes. Effect of other factors such as anaesthesia and low blood pressure did not reach the warning standards. There were 3 artifical negative cases. Only 1 was artifical positive case. of