摘要
目的评估运动诱发电位（MEP）、体感诱发电位（SEP）以及脑电图（EEG）单独监测及联合监测在颈动脉内膜切除术（CEA）中预防脑缺血的临床价值。方法选择自2014年6月至2016年7月在天津医科大学总医院神经外科行CEA的62例患者。所有患者术中均行MEP、SEP、EEG检查，将患者SEP、MEP波幅降低〉50%、潜伏期延迟〉10%，或EEG的频率改变超过50%定义为预警标准。分别对3种检查模式单独及联合应用的预测效果进行比较。结果62例患者中，MEP出现预警11例，SEP出现预警15例，EEG出现预警8例。术后5例患者神经功能症状发生一过性加重。除了EEG与3种两两联合监测模式之间特异性差异无统计学意义外（P〉0.05），SEP、MEP单独监测模式与3种两两联合监测模式之间的特异性差异均有统计学意义（P〈0.05），两两联合监测模式特异性明显高于SEP、MEP单独监测模式。SEP＋MEP＋EEG三联监测模式与两两联合监测模式特异性差异无统计学意义（P〉0.05）。结论CEA术中神经电生理联合监测模式较单独监测模式能明显降低＂假阳性率＂的判断，MEP＋SEP。
Objective To evaluate the clinical application value of motor evoked potential （MEP） combined with somatosensory evoked potential （SEP） and electroencephalogram （EEG） in carotid endarterectomy （CEA） in prevention of cerebral ischemia. Methods The clinical data of 62 patients accepted CEA in our hospital from June 2014 to July 2016 were analyzed retrospectively. During the operation, MEP, SEP and EEG were examined, and the bypass tube would be considered when SEP/MEP amplitude was decreased by 50%, latency was delayed by 10%, or frequency of EEG was changed by 50%. The predictive effects of each method and combined application of 3 methods were compared. Results In 62 patients, MEP changes occurred in 11 patients, SEP changed in 15 patients and EEG changed in 8 patients. Six patients applied bypass tube during operation and a transient neurological dysfunction occurred in 5 patients. The specificity of EEG mode showed no statistical differences as compared with that of SEP＋MEP, EEG＋MEP, and SEP＋EEG modes （P〉0.05）, while that of SEP mode or MEP mode was significantly lower as compared with that of SEP＋MEP, EEG＋MEP, and SEP＋EEG modes （P〈0.05）. The specificity of SEP＋MEP＋EEG mode showed no statistical differences as compared with that of SEP＋MEP, EEG＋MEP, and SEP＋EEG modes （P〉0.05）. Conclusion Multi-mode neural electrophysiological monitoring is safer and more effective than single mode in CEA; MEP＋SEP monitoringmode is the preferred monitoring program in CEA.
作者
宫达森
崔云
岳树源
Gong Dasen;Cui Yun;Yue Shttyuan(Department of Neurosurgery,General Hospital,Tianjin Medical University,Tianjin 300052,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2018年第10期1037-1040,共4页
Chinese Journal of Neuromedicine
关键词
颈动脉内膜切除术
运动诱发电位
感觉诱发电位
脑电图
Carotid endarterectomy
Motor evoked potential
Somatosensory evokedpotential
Electroencephalogram
