SEP监测在甲基泼尼松龙防治脊髓损伤中的作用论文.docVIP

　　SEP监测在甲基泼尼松龙防治脊髓损伤中的作用论文 【摘要】 目的 探讨脊柱手术中体感诱发电位（SEP）监测脊髓功能在指导甲基泼尼松龙(MP)大剂量冲击治疗脊髓损伤中的价值。方法 颈、胸椎手术病人280例，术前SEP正常术中SEP变化未达到预警标准168例。术前SEP异常术中SEP变化未达到预警标准80例，分为两组，A1组40例术中应用大剂量MP冲击疗法，B1组40例应用甘露醇和地塞米松常规治疗，观察两组早期脊髓功能改善情况。SEP术中达到预警标准32例分为两组：A2组22例治疗同A1组，B2组10例治疗同B1组，观察两组早期脊髓功能改善情况。结果 SEP术中未达到预警标准术前无SEP异常者168例.freelatosensory evoked potential (SEP) in monitoring the function of spinal cord and guiding the use of methylprednisolone pulse therapy during surgery for spinal cord injury. Methods Among 280 cases of cervical and thoracic operation, 168 shoal SEP preoperatively but the changes did not reached the precaution standard at surgery, 80 shoal SEP preoperatively and the changes of SEP at operation did not reached the precaution standard. The latter 80 cases ethylprednisolone pulse therapy; group B1, received routine treatment annitol and dexamethasone. For those 32 cases e therapy as group A1, group B2 received the same therapy as group B1. The earlystage improvement of spinal cord function of the above four groups al preoperative SEP but did not reached the precaution standard value of SEP at operation shoptoms of spinal cord injury. There s of the improvement of neurological symptoms; ent standard, ethylprednisolone should be given to prevent further spinal cord injury and promote the recovery of spinal cord function. For those al preoperative SEP and loent standard SEP at operation, methypredinisolone pulse therapy is beloark. ［KEY ethylprednisolone; Treatment oute 自1978年ENGLER等1首先报道体感诱发电位（SEP）在脊柱手术中的监护作用以来， SEP已广泛地应用于各种与脊柱相关疾病的术中监护2，SEP监测对反映术中脊髓是否损伤有重要意义。而甲基泼尼松龙(MP)大剂量冲击治疗急性脊髓损伤的效果已被临床证实3～5。本研究使用SEP术中监测脊髓功能，旨在评价根据SEP监测结果指导术中应用大剂量MP冲击治疗防治脊髓损伤的价值。现将结果报告如下。 1 资料与方法 1.1 一般资料 颈、胸椎手术病人280例，男158例，女122例；年龄16～79岁，平均56.5岁。包括颈椎管狭窄及肿瘤、胸椎管狭窄及肿瘤，脊柱侧弯，颈、胸椎骨折等。以上病例手术中均需高危操作，包括肿瘤切除、椎管减压、椎弓根螺钉置入、椎板钩置入、椎体切除等。术前SEP正常者术中SEP未达到预警标准168例，术后无神经损伤症状，不列入分组。术前SEP异常术中SEP未达到预警标准，神经症状重者80例，分为两组。A1组40例应用大剂量MP冲击治疗，B1组40例应用甘露醇和地塞米松常规治疗，作为对照组。术中SEP监测达到预警标准32例分为两组，A2组22例应用MP大剂量冲击治疗，B2组10例用甘露