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| 体感诱发电位联合运动诱发电位监测在颈动脉内膜剥脱术中的应用 |
| Somatosensory evoked potential and motor evoked potential in detecting the occurrence of intraoperative cerebral ischemia in patients undergoing carotid endarterectomy |
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| DOI： |
| 中文关键词: 颈动脉内膜剥脱术 体感诱发电位 运动诱发电位 脑缺血 |
| 英文关键词: Carotid endarterectomy Somatosensory evoked potential Motor evoked potential Brain ischemia |
| 基金项目:首都特色应用研究（Z141107002514123）;北京市医院管理局“扬帆计划”重点医学方向（ZYLX201708）;首都卫生发展科研专项重点攻关项目（2016-1-20410） |
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| 中文摘要: |
| 目的 评估在颈动脉内膜剥脱术中 (carotid endarterectomy，CEA)中采用体感诱发电位 (somatosensory evoked potential，SSEP)与运动诱发电位 (motor evoked potential，MEP)联合监测的方案对于预防术中脑缺血发生的准确性。方法 选择因颈动脉狭窄择期拟行CEA患者90例，男71例，女19例，年龄18～80岁，ASA Ⅱ或Ⅲ级。术中监测SSEP和MEP，记录颈内动脉阻断前、颈动脉阻断时、阻断期间及开放后直至术毕SSEP和MEP波幅和潜伏期。评估术后5 d内神经功能缺失情况，以发生神经功能缺失作为评判术中脑缺血发生的金标准。结果 本研究中14例（15.6%）患者发生术后神经功能缺失。SSEP预测脑缺血发生的灵敏度79%、特异度92%;MEP预测脑缺血发生的灵敏度86%、特异度89%、SSEP+MEP联合监测的灵敏度为79%、特异度99%。结论 在颈动脉内膜剥脱术中，体感诱发电位预测脑缺血发生的特异度高，运动诱发电位灵敏度高;二者联合监测可提高监测的特异性，弥补单一监测的不足。 |
| 英文摘要: |
| Objective To investigate the accurancy of somatosensory evoked potential (SSEP) and motor evoked potential (MEP) in estimation of the occurrence of intraoperative cerebral ischemia in patients undergoing carotid endarterectomy (CEA). Methods Ninety patients (71 males, 19 females, aged 18-80 years, ASA physical status grade Ⅱ or Ⅲ) undergoing CEA using general anesthesia were studied. Bilateral SSEP and MEP were monitored during CEA and the intraoperative changes of SSEP and MEP amplitude and latency were analyzed before, during and after ICA cross clamping until CEA ended. Neurological dysfunction was investigated within 5 days after operation and the gold standard of cerebral ischemia was defined as the occurrence of neurological dysfunction. Results Fourteen cases (15.6%) were diagnosed as post-operative neurological dysfunction. The sensitivity, specificity of SSEP in detecting the occurrence of intraoperative brain ischemia were 79%, 92%, respectively. The sensitivity, specificity of MEP was 86%, 89% respectively. The sensitivity, specificity, of SSEP+MEP was 79%, 99% respectively. Conclusion During the carotid endarter ectomy,SSEP predicts the occurrence of cerebral ischemia with a high specificity. MEP has a high sensitivity. The combination monitoring of SSEP+MEP can improve the specificity, make up for the shortcomings of single monitoring. |
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