CAJ | 학술논문

目的通过对脊柱侧凸手术术中躯体感觉诱发电位(SEP)监护波形进行分析,记录术后神经功能状态,探讨基线的选择时机和警戒标准,以更精确地指导手术.方法回顾性分析西安交通大学附属红会医院2011年3月至2014年12月间收治的113例接受手术治疗的脊柱侧凸患者,比较麻醉后切皮前(以下简称麻醉后)和暴露椎板后(以下简称暴露后)的SEP潜伏期、波幅的差异性,并将术中SEP波幅变化与暴露椎板后的基线进行比对,按波幅降低幅度的大小分为4组:A组(降低＜40％),B组(降低40％～50％),C组(降低50％～60％)和D组(降低＞60％以上),记录各组患者术后的神经功能状况.结果麻醉后和暴露后的SEP波形差异有统计学意义(P＜0.01),暴露后的潜伏期较麻醉后延长(3.28±1.72)ms(左下肢)和(3.30±2.09) ms(右下肢),暴露后的波幅较麻醉后降低0.17(0.39)μV(左下肢)和0.19(0.40) μV(右下肢);C、D组患者术后神经功能损害差异有统计学意义(P＜0.05).结论脊柱侧凸手术术中SEP监护以暴露后的SEP波形作为基线可提高SEP监护的准确性.术中若以波幅降低超过50％作为报警标准过于敏感,以波幅降低超过60％作为报警标准方可降低报警的假阳性率.
목적 통과대척주측철수술술중구체감각유발전위(SEP)감호파형진행분석,기록술후신경공능상태,탐토기선적선택시궤화경계표준,이경정학지지도수술.방법 회고성분석서안교통대학부속홍회의원2011년3월지2014년12월간수치적113례접수수술치료적척주측철환자,비교마취후절피전(이하간칭마취후)화폭로추판후(이하간칭폭로후)적SEP잠복기、파폭적차이성,병장술중SEP파폭변화여폭로추판후적기선진행비대,안파폭강저폭도적대소분위4조:A조(강저＜40％),B조(강저40％～50％),C조(강저50％～60％)화D조(강저＞60％이상),기록각조환자술후적신경공능상황.결과 마취후화폭로후적SEP파형차이유통계학의의(P＜0.01),폭로후적잠복기교마취후연장(3.28±1.72)ms(좌하지)화(3.30±2.09) ms(우하지),폭로후적파폭교마취후강저0.17(0.39)μV(좌하지)화0.19(0.40) μV(우하지);C、D조환자술후신경공능손해차이유통계학의의(P＜0.05).결론 척주측철수술술중SEP감호이폭로후적SEP파형작위기선가제고SEP감호적준학성.술중약이파폭강저초과50％작위보경표준과우민감,이파폭강저초과60％작위보경표준방가강저보경적가양성솔.
Objective To explore the choice of timing for baseline and alert levels of somatosensory evoked potential (SEP) monitoring during scoliosis surgery.Methods From March 2011 to December 2014,a total of 113 patients with kyphoscoliosis deformity were monitored intraoperatively by SEP.There were 52 males and 61 females with a mean age of (20 ± 15) years.All the patients were recorded preoperativeandintraoperative SEPs on double lower limbs.Latency and amplitude of SEPs were recorded after anesthesia and vertebral laminae exposure respectively and compared with each other.Intraoperative SEPs were compared to baseline as SEP after exposure and divided into 4 groups of A (＜40％),B(40％-50％),C (50％-60％) and D (＞ 60％) according to the reduced amplitude.Nerve functions were recorded during follow-ups.Results Significant statistical difference existed between SEPs post-anesthesia and SEPs after vertebral laminae exposure (P ＜0.01).Compared with SEP post-anesthesia,the latency of SEP after exposure was prolonged with (3.28 ± 1.72) ms (left lower limb) and (3.30 ± 2.09) ms (right lower limb) and amplitude decreased with 0.17 (0.39) μV (left lower limb) and 0.19 (0.40) μV (right lower limb).There was a positive relationship of impaired nerve function between groups C and D (P ＜ 0.05).Conclusion Adopting SEP waveform after exposure as a baseline can improve the accuracy of SEP monitoring during scoliosis surgery.Intraoperative alarm with a reduced amplitude over 50％ as the standard may be too sensitive.Alert with a reduced amplitude of over 60％ reduces the false positive rate of alarm.