CAJ | 학술논문

目的探讨全静脉麻醉下经颅电刺激运动诱发电位(TES-MEPs)联合体感诱发电位(SEP)监测颅内前循环动脉瘤手术及预防缺血性卒中的应用价值.方法 47例颅内动脉瘤夹闭手术患者,术中行SEP和TES-MEPs联合监测,以神经功能检查作为评价指标,比较术前和术后神经功能的改变和诱发电位变化之间的关系.结果 43例神经功能未见显著改变,4例神经功能出现不同程度下降,其中3例MEP及SEP同时出现波幅下降＞50%或消失,且手术结束时未恢复至基线水平,与术后神经功能障碍发生具有一致性.结论术中监测指标的改变可较早地获得脑缺血的证据,联合SEP与MEP监测有利于降低术后缺血性脑卒中的发生.
목적 탐토전정맥마취하경로전자격운동유발전위(TES-MEPs)연합체감유발전위(SEP)감측로내전순배동맥류수술급예방결혈성졸중적응용개치.방법 47례로내동맥류협폐수술환자,술중행SEP화TES-MEPs연합감측,이신경공능검사작위평개지표,비교술전화술후신경공능적개변화유발전위변화지간적관계.결과 43례신경공능미견현저개변,4례신경공능출현불동정도하강,기중3례MEP급SEP동시출현파폭하강＞50%혹소실,차수술결속시미회복지기선수평,여술후신경공능장애발생구유일치성.결론 술중감측지표적개변가교조지획득뇌결혈적증거,연합SEP여MEP감측유리우강저술후결혈성뇌졸중적발생.
Objective To investigate the value of combined monitoring of motor evoked potentials (MEP) and somatosensory evoked potentials (SEP) on the prevention of ischemic stroke in anterior circulation aneurysms surgery under total intravenous anesthesia. Method 47 patients of anterior circulation aneurysms were monitored SEP and MEP during the operation,the postoperative and preoperative neurological function variation and the relationship with monitoring outcome were compared.Result There was no significant change in neurological function in 91% patients(43/47).In 4/47 (9%) patients,we observed decreased nerve function with different degrees. Among these 4 patients,3 with motor evoked potentials and somatosensory evoked potentials amplitude declined＞50% or disappeared simultaneously,moreover there was no recovery to baseline level after surgery,which were consistent with postoperative neurological deficit.Conclusion The changes of intraoperative monitoring indicators can be obtained for earlier indication of cerebral ischemia.The combined monitoring of SEP and TES-MEPs could improve the outcomes significantly for patients with aneurysms.It might be helpful to avoid postoperative ischemic stroke.