摘要
目的探讨躯体感觉诱发电位(SEP)在颅内动脉瘤栓塞术中的应用价值。方法 2007年3月至2010年12月血管内栓塞治疗大脑中动脉(MCA)动脉瘤患者31例和大脑前动脉(ACA)动脉瘤患者25例,均行术中SEP监测,分析术中SEP的异常情况。结果共24例患者SEP发生异常(波幅下降>50%和潜伏期延长>10%),其中MCA动脉瘤栓塞时16例,ACA动脉瘤栓塞时8例。MCA动脉瘤栓塞时上肢SEP异常10例(32.3%),下肢SEP异常1例(3.2%),上下肢SEP均异常5例(16.1%)。ACA动脉瘤栓塞时,下肢SEP异常7例(28.0%),上下肢均异常1例(4.0%)。两组动脉瘤栓塞时上肢及下肢SEP异常率均差异明显(P<0.05)。MCAM1段动脉瘤栓塞术中SEP异常率最高,达37.5%(9/24)。SEP异常患者经术中干预后,21例SEP完全恢复正常,其中19例无新发神经功能障碍,1例下肢轻瘫,1例出现头晕;3例SEP部分恢复,术后出现相应的神经功能障碍。结论颅内动脉栓塞术中SEP监测有利于及时发现脑组织缺血(SEP异常)并及时给予术中干预,对降低患者脑梗死发生率及改善患者预后有重要意义。
Objective To investigate the applied value of monitoring somatosensory evoked potential （SEP） to the endovascular embolization of the middle cerebral artery （MCA） and anterior cerebral artery （ACA） aneurysms.Methods SEP was monitored during the endovascular embolization from March,2007 to December,2010 in 31 patients with MCA aneurysms and 25 patients with ACA aneurysms.The abnormalities of SEP were analyzed during the endovascular embolization.Results The abnormal SEP including the decrease in its wave amplitude and increase in its latent period during the endovascular embolization was observed in 16 patients with MCA aneurysms and 8 patients with ACA aneurysms.Of MCA aneurysms 16 patients with abnormal SEP,10（32.3%） had abnormal SEP on the upper limbs,1（3.2%） on the lower limb and 5 （6.1%） on the upper and lower limbs during the endovascular embolization.Of 8 ACA aneurysms patients with abnormal SEP,7 （28.0%） had abnormal SEP on the lower limbs and 1 （4.0%） on the upper and lower limbs.The abnormal rate of SEP on the upper limbs was significantly higher,and the abnormal rate of SEP on the lower limbs was significantly lower in the patients with MCA aneurysms than those in the patients with ACA aneurysms （P 0.01）.The abnormal rate [37.5% （9/24）] of SEP was highest during the embolization of the first section aneurysms of the MCA.SEP returned to normal in 21 patients with abnormal SEP and SEP did not completely returned to normal in 3 patients with abnormal SEP after the intraoperative treatment.There were the different neurological function disturbance after the operation in 5 of 24 patients with abnormal SEP.Conclusions ① The abnormal SEP during the embolization may be related to the cerebral tissues ischemia.② The monitoring SEP during the endovascular embolization is helpful to finding the cerebral ischemia in the patients with intracranial aneurysms,whose prognoses can be improved by the timely treatment of the cerebral ischemia.
出处
《中国临床神经外科杂志》
2011年第6期329-332,共4页
Chinese Journal of Clinical Neurosurgery
关键词
动脉瘤
大脑中动脉
大脑前动脉
血管内栓塞术
躯体感觉诱发电位
Aneurysm
Anterior cerebral artery
Middle cerebral artery
Endovascular embolization
Somatosensory evoked potential
