摘要
目的探讨脊柱侧凸手术中经颅电刺激运动诱发电位（transcranial electrical stimulation motor evoked potential，TES-MEP）和皮层体感诱发电位（cortical somatosensory evoked potential，CSEP）联合监护的可行性和应用价值。方法2006年7月至2008年4月，在脊柱侧凸手术中同时记录双侧胫前肌、足跨短屈肌TES-MEP和双侧胫后神经CSEP76例。实施全静脉麻醉49例，七氟烷（吸入浓度〈1％）＋异丙芬复合麻醉27例。对各麻醉组的TES-MEP检出结果进行四格表x。检验，并对术中两种电位的真、假阳性和真、假阴性结果进行相关的指数统计分析。结果TES-MEP和CSEP成功检出率均为96．1％，而两种麻醉组的TES-MEP检出率差异无统计学意义。术中诱发电位阳性11例，其中9例为真阳性，均与手术操作不当直接有关。CSEP、TES-MEP、联合监护的灵敏度分别为75．0％、87．5％和100％，特异度分别为98．5％、98．5％和97．0％，约登指数分别为0．74、0．86和0．97。结论实施异丙芬静脉麻醉为主，辅以七氟烷吸入浓度〈1％的复合麻醉，也是联合监护切实可行的麻醉方案；联合监护对脊髓功能监测的敏感性和准确性明显高于单一的TES-MEP或CSEP监护。
Objective To investigate the feasibility and applied value of transcranial electrical stimulation motor evoked potential （TES-MEP） combined with cortical somatosensory evoked potential （CSEP） monitoring during the surgery of scoliosis. Methods From July 2006 to April 2008, 76 patients were simultaneously recorded the TES-MEP on bilateral anterior tibial muscle and flexor hallucal brevis and the CSEP on bilateral posterior tibial nerve during the surgery of scoliosis. Forty-night of these patients received total intravenous anesthesia and the other 27 patients were anesthetized by propofol and sevoflurane （inhalant concentration 〈1%）. The results of TES-MEP in both groups were analyzed by χ^2 analysis and related index about the true positive, false positive and true negative, false negative results were calculated. Results Success rates of TES-MEP and CSEP recording were both 96.1%. There was no statistics difference of the success rate of TES-MEP in the two different anesthesia groups. Evoked potentials changes occurred in 11 cases, in which 9 cases were true positive results in direct relation to an incorrect operative maneuver. The sensitivity of the CSEP, TES-MEP and muhimodality recording was 75.0%, 87.5% and 100%, respectively. The specificity of the three methods was 98.5%, 98.5% and 97.0%, respectively. The Yonden index of the three methods was 0.74, 0.86 and 0.97, respectively. Conclusion The anesthesia by intravenous propofol and sevofturane （inhalant concentration 〈1%） was a feasible method for muhimodality recording. The sensitivity and precision of muhimodality recording for detecting spinal cord function were apparently higher than that of unitary TES-MEP or CSEP monitoring.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2009年第1期27-31,共5页
Chinese Journal of Orthopaedics
关键词
脊柱侧凸
电刺激
诱发电位
运动
诱发电位
躯体感觉
Scoliosis
Electric stimulation
Evoked potentials,motor
Evoked potentials, somatosensory
