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脊柱脊髓手术中皮层体感诱发电位 CSEP 监护的临床研究 |
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沈宁江 王书成 黄世敏 张岚
摘要 目的：通过开展皮层体感诱发电位(CSEP)术中监护脊髓功能的临床研究，有效的预防医原性脊髓损伤，杜绝截瘫的发生。方法：60例手术患者按Frankel分级术前属B级11例，C级19例，D级12例，E级 18例，CSEP术中连续动态监测。作者经实验研究并结合临床提出CSEP术中监护临界值为：D、E级患者术中波幅较麻醉后下降不超过50％，潜伏期延长不超过70％；B、C级患者术中波幅较麻醉后下降不超过40％，潜伏期延长不超过50％。结果：45例未达到监护临界值，术后无脊髓损伤。超过临界值发出警告15例，其中13例接受警告术后脊髓功能无损害，2 例不顾警告继续手术，术后发生完全性截瘫。结论：CSEP术中监护脊髓损伤准确可靠，值得推广应用。
关键词 CSEP 手术中监护 脊髓损伤
Clinical Study on CSEP Monitoring in Spinal Surgery Shen Ninjiang, Wang Shucheng, Huang Siming, et al. Department of Orthopaedics, People s Hospital of Hainan Province, Haikou 570311
Abstract Purpose: In order to prevent iatrogenic spinal cord injury nad prevent paraplegia, a clinical study of cortical somatosensory evoked potential ( CSEP) monitoring in spinal surgery was carried out. Methods: According to Frankel s grade, spinal cord function of 60 cases before operation, was B grade in 11 cases, C grade 19 cases, D grade 12 cases, E grade 18 cases. The spinal cord was dynamically monitored by CSEP in operation. The critical limits of CSEP intraoperative monitoring were put forward as follows by our experimental study combining clinical grade: the declined amplitued should be less than 50% and the prolonged latency should be less than 70% compared with that of preoperation in grade D and E grade cases. But, in B and C grade patients, the declined amplitude should be less than 40% and the prolonged latency should be less than 50% compared with that of preoperation. Results: 45 cases did not reach the critical limits, so the spinal cord was not injuried after operation. 15 cases were given warning due to overtaken the critical limits. The warning was accepted by the surgeon and the spinal cord function was not injuried in 13 cases. But in another 2 cases, the operation was performed disregarding warning so that the complete paraplegia ocured after operation. Conclusion: Intra-operative CSEP monitoring spinal cord injury is accurate and reliable.
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