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ID:19407141
大小:32.00 KB
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时间:2018-10-02
《脊髓及神经根监测技术在脊柱外科手术中的应用.doc》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
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
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