脊髓及神经根监测技术在脊柱外科手术中的应用.doc

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1、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（somatosensoryevokedpotential,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

2、］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10min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

3、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］Toevaluatetheaccuracyandinfluenceingfactorsofsomatosensoryevokedpotentialinspinalcordmonitoringduringcervicalandthoracicspinalsurg

4、eryandintraoperativenerverootmonitoringinlumbarsurgery.［Method］Thesomatosensoryevokedpotential(SEP)wereusedduringarvicalandthoracicspinalsurgeryandevaluatedtheaccuracyofSEPaccordingtotherecordofdifferentstagesandspinalcordfunctionaftersurgery.TheEMGwer

5、eusedtomonitorthenerverootfunctioninlumberoperationtoestimatewhethernerverootbeingstimulatedortensioned.Inaddition,affectedfatorsofSEPandEMGduringoperationwereobserved.［Result］Of128casesofcervicalandthoracicsurgery,116casesdidnotreachthewarningstandard

6、s(amplitudedecreasing50%ordiappearing)andshowednopostoperativeenhancementofsymptomofnerverootsinjury.12casesreachedthewarningstandardsintraoperativelyandthesurgeonwerewarnedtotakesomestepstofinishtheoperations,onlyinonecaseincompletelytransientparalysi

7、soccurredduetothetimeofamplitudedecreasingofintraoperativeSEPmorethan10minutes.Effectofotherfactorssuchasanaesthesiaandlowbloodpressuredidnotreachthewarningstandards.Therewere3artificalnegativecases.Only1wasartificalpositivecase.of40casesoflumbarsurger

8、y,12caseswerefoundmyoelecticresponses,whichwarningthesurgeonatany5timetoavoidnerverootsinjury,nonerverootsinjurywerefoundafteroperation.［Conclusion］Duringcervicalandthoracicspinaloperation,thesomatosensoryevokedpotentialcanreflectthephy