SSEP、MEP和DNEP在重度脊柱畸形截骨矫形术中同时联合监测的意义

目的探讨在重度脊柱畸形截骨矫形术中,体感诱发电位（somatosensory evoked potential,SSEP）、运动诱发电位（motor evoked potential,MEP）和下传神经源性诱发电位（descending neurogenic evoked potential,DNEP）同时联合监测的安全性和准确性。方法回顾性分析2010年8月～2011年7月采用3种诱发电位同时联合监测的重度脊柱畸形截骨矫形患者16例,所有患者均在全静脉麻醉并小剂量肌松剂泵注维持下行脊柱畸形截骨矫形术,术中均行SSEP、MEP和DNEP同时联合监测。结果 16例患者术中出现3种诱发电位皆阳性5例,唤醒试验也为阳性,术后均出现不同程度的神经并发症。单纯MEP阳性,而SSEP、DNEP正常者4例,术中唤醒试验均为阴性,术后无异常神经体征。单纯SSEP阳性,而MEP、DNEP正常者1例,术中唤醒阴性,术后查体正常。另外6例术中SSEP、MEP和DNEP皆正常,但其中1例考虑因神经根牵拉出现术后一过性股四头肌肌力下降,余5例术后查体均正常。结论术中DNEP与SSEP、MEP同时联合监测可减少传统SSEP和MEP监测产生假阳性对手术的干扰,对重度脊柱畸形截骨矫形术中脊髓损伤监测具有较好的敏感性和准确性,术中如有2种及以上诱发电位异常则出现脊髓损伤的可能性增大。     

经颅刺激运动诱发电位联合体感诱发电位监测在脊柱畸形手术中的应用

 目的分析联合应用经颅刺激运动诱发电位(transcranial electric stimulation motor evoked potential, TcMEP)+体感诱发电位(somatosensory-evoked potential, SEP)的多模式术中神经功能监测对预 测脊柱畸形矫形手术中医原性神经功能损害的意义。方法 在脊柱畸形矫形手术中, 同时应用 TcMEP 和(或)SEP进行神经功能监测。 MEP监测采用经颅刺激 ₃、C₄, 记录外周肌源性 MEP, SEP监测采用刺 激双侧胫后神经, 记录置于 C_z-FP_z。阳性诊断标准为, 与基线相比, MEP波幅下降 75%, SEP波幅下降 50%。结果 153例脊柱畸形患者中, 150例成功进行了术中 MEP监测, 83例进行了术中 SEP监测。联 合 MEP、SEP监测的检出率为 100%。MEP监测阳性共 12例, 所有患者中有 1例出现永久性神经功能障 碍, 4例出现一过性神经功能障碍。 MEP监测的敏感性为 90.9%, 特异性为 98.6%; SEP监测敏感性为 54.5%, 特异性为 94.3%;联合 MEP、SEP监测的敏感性达 92.3%, 特异性为 99.3%。结论 联合 MEP+ SEP的多模式术中神经功能监测可提高监测的敏感性及特异性, 可预测术中神经功能损伤事件的发生。 MEP是多模式监测的基础, 而 SEP是重要补充。     

经颅刺激运动诱发电位联合体感诱发电位监测在特发性脊柱侧凸矫形手术中应用的研究

背景：特发性脊柱侧凸手术治疗中神经功能障碍是最应受到关注的并发症,术中神经功能监测可帮助早期发现可能的神经功能损伤。目的：分析联合应用经颅刺激运动诱发电位（TcMEP）和体感诱发电位（SEP）的多模式术中神经功能监测在特发性脊柱侧凸矫形手术中对预测医源性神经功能损害的作用。方法：在特发性脊柱侧凸矫形手术中,运用TcMEP和（或）SEP进行神经功能监测。MEP监测采用经颅刺激C3、C4,记录外周肌源性MEP,SEP监测采用刺激双侧胫后神经,记录电极采用Cz—CPz。阳性诊断标准：与基线相比,MEP波幅下降75％,SEP波幅下降50％。结果：112例特发性脊柱侧凸患者中,联合MEP、SEP监测的检出率为100％。MEP监测阳性6例,假阳性1例。1例出现一过性神经功能障碍。MEP的监测敏感性为100％,特异性为99％;SEP监测敏感性50％,特异性为100％;联合MEP、SEP监测的敏感性、特异性均为100％。结论：特发性脊柱侧凸矫形手术中MEP＋SEP的术中神经功能监测可提高监测敏感性及特异性,可预测术中神经功能损伤事件的发生。MEP是多模式监测的基础,SEP是重要补充。单独应用MEP监测在特发性脊柱侧凸患者手术中有应用前景。     

生长棒撑开术中经颅刺激运动诱发电位和体感诱发电位监测的应用价值

目的:分析生长棒撑开术中经颅刺激运动诱发电位(MEP)和体感诱发电位(SEP)神经功能监测的应用价值。方法:回顾性分析2010年10月~2015年1月我院进行的65例141次生长棒撑开手术,在生长棒撑开术中,运用MEP和SEP进行神经功能监测。MEP监测采用经颅刺激C3、C4,记录外周肌源性MEP,SEP监测采用刺激双侧胫后神经,记录电极采用Cz-CPz。阳性诊断标准:与基线相比,MEP波幅下降75%,SEP波幅下降50%或潜伏期延长10%。结果:141例次撑开手术中成功获得具有监护价值且重复性较好MEP 139例次,检出率98.6%,全程失败2例次(占1.4%);SEP成功监测140例次,检出率99.3%,失败1例(占0.7%)。所有患者均能成功记录到一种以上的诱发电位。本组141例次手术中未出现MEP及SEP监测阳性。所有患儿术后神经系统检查均无异常发现,神经功能监测结果均为真阴性。结论:生长棒撑开术是简单安全的手术操作,但是,运用MEP和SEP进行术中神经功能监测可以为生长棒撑开术提供客观的安全评估指标。     

经颅电刺激运动诱发电位和皮层体感诱发电位在脊柱侧凸手术中联合监护的观察研究

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(足母)短屈肌TES-MEP和双侧胫后神经CSEP 76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χ2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,也是联合监护切实町行的麻醉方案;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.     

颈椎外伤前路手术中体感诱发电位监护应用

目的探讨体感诱发电位(somatosensory evoked potential,SSEP)在颈椎外伤前路手术中的作用。方法 2008-07-2015-02收治颈椎外伤前路手术患者53例,年龄16~69岁,男44例,女9例。对照组(33例)无SSEP监护,监护组20例。在麻醉诱导后摆放体位前确立SSEP基线,波幅降低50%或潜伏期延长10%为报警标准。记录SSEP报警因素、改善措施及有无医源性神经损伤。计算SSEP监护神经损伤的敏感性和特异性。结果 53例病人术后未出现新的神经损伤。SSEP监护颈椎外伤前路手术中神经损伤的敏感性和特异性为100%。结论在颈椎外伤前路手术中SSEP监护医源性神经损伤是有意义的。     

颈静脉球血氧饱和度、体感诱发电位和运动诱发电位评估颅内动脉瘤夹闭术患者脑缺血发生准确性的比较

目的 比较颈静脉血氧饱和度(SjvO2)、体感诱发电位(SSEPs)和运动诱发电位(MEPs)评估颅内动脉瘤夹闭术患者脑缺血发生的准确性.方法 拟行颅内动脉瘤夹闭术患者43例,性别不限,年龄18～64岁,BMI 20 ～ 25 kg/m2,ASA分级Ⅰ或Ⅱ级.气管插管后机械通气,采用丙泊酚-瑞芬太尼全凭静脉麻醉,分别于记录动脉瘤夹闭或载瘤动脉临时阻断前、动脉瘤夹闭或载瘤动脉临时阻断后1、3、10、20、30 min时采集颈内球部血样,测定SjvO2,并于上述时点记录SSEPs和MEPs的波幅及潜伏期,分别记录3种指标判断术中脑缺血发生情况,记录术后3d内神经缺损情况,以发生神经缺损作为判断术中脑缺血发生的金标准.结果 术中发生脑缺血14例.SjvO2评估术中脑缺血发生的灵敏度和特异度分别为71％和93％(P＜0.01);SSEPs评估术中脑缺血发生的灵敏度和特异度分别为71％和62％(P＜ 0.05);以MEPs波幅降低或潜伏期延长作为判断脑缺血发生标准时,评估术中脑缺血发生的灵敏度和特异度分别为79％和52％(P＞ 0.05),以MEPs波幅消失作为判断脑缺血发生标准时,评估术中脑缺血发生的灵敏度和特异度分别为57％和93％(P＜0.05).结论 SjvO2和SSEPs评估颅内动脉瘤夹闭术患者脑缺血发生的灵敏度较高,而SjvO2和MEPs评估脑缺血发生的特异度较高,提示SjvO2是评估脑缺血发生的可靠指标.     

脊柱外科术中皮层体感诱发电位监护与临床研究

脊柱外科术中脊髓功能的监测方法有：①术中唤醒试验；②皮层体感诱发电位（cortical somatosensory evoked potential，CSEP）监护；③运动诱发电位监测。（moter evoded potedntial，MEP）监护。CSEP监测．近几年在脊柱手术中应用逐渐增多．尽管有许多局限性．但由于操作简单，容易记录、重要性好。不影响手术视野．不需禁用肌松药等优点．在脊柱手术中有一定的实用价值。本院自2004年7月至2005年11月．有选择性对部分重大疑难脊柱手术行术中CSEP监护．大大减少了脊柱外科手术中脊髓损伤的机会．增加手术安全性．并具有法医学上的潜在价值。     

神经根不同程度慢性嵌压伤的恢复过程与诱发电位表现

目的研究神经根在不同程度慢性损伤状态下的恢复过程与机制,确定反映具有不可逆性损伤的诱发电位警界指标,为临床选择治疗时机、方法和判断预后提供依据. 方法家猫30只,体重3～5 kg,雌雄不限.在右侧C7～8和C8～T1两个椎间孔内植入自体松质骨,造成脊神经根慢性损伤的病理模型,左侧为自身对照.通过24周观察和诱发电位动态监测,确定神经损伤程度, 并分为损伤程度Ⅰ～Ⅴ度5组.再分别解除神经根嵌压,此后的32周内,每周行诱发电位检测和病理组织学检查,观察各损伤组功能恢复情况. 结果Ⅰ、Ⅱ度神经损伤,在2～6周内组织形态和神经功能恢复正常.Ⅲ度损伤,神经恢复最早出现在第4周,至12周后可逐渐恢复正常.Ⅳ度损伤恢复过程缓慢,6只动物中仅有3只可完全恢复,2只部分功能改善,1只未恢复.Ⅴ度损伤,神经根传导功能和组织形态学改变几乎不再恢复.结论在监测损伤神经根恢复的过程中,电刺激体感诱发电位(sensitive evoked potential,SEP)指标是反映恢复早期的敏感指征;磁刺激运动诱发电位(motion evoked potential,MEP)是确定恢复程度的可靠指征.     

神经电生理监测在颈动脉内膜切除术中的价值

目的 探讨神经电生理监测在颈动脉内膜切除术(CEA)中的应用价值。方法 回顾性分析2018-01—2020-12于河南大学淮河医院神经外科行CEA治疗的16例颈动脉重度狭窄患者的临床资料。男9例,女7例;年龄62.2岁(范围：52～71岁)。术中同时监测患者的运动诱发电位(MEP)和感觉诱发电位(SEP),将MEP和SEP波幅降低>50%或潜伏期延迟>10%视为血流量不足导致神经功能受损的危险信号,并根据监测结果及时使用转流管。术后按照美国国立卫生研究院卒中量表(NIHSS)评分,评估神经功能并发症情况。统计随访6个月期间再狭窄的发生率。结果 16例患者手术过程顺利,术中血流阻断后记录到危险信号2例(12.50%),予以置放转流管。术后1例(6.3%)患者出现神经功能障碍。患者术后均获随访6个月,其间复发1例(6.3%),其余患者恢复良好。结论 术中神经电生理监测对减少CEA后脑缺血并发症和提高围手术期安全性具有一定的指导价值。     

Auditory evoked potential index: a quantitative measure of changes in auditory evoked potentials during general anaesthesia

We describe a novel index derived from the auditory evoked potential, the auditory evoked potential index, and we compare it with latencies and amplitudes related to clinical signs of consciousness and unconsciousness. Eleven patients, scheduled for total knee replacement under spinal anaesthesia, completed the study. The initial mean (SD) value of the auditory evoked potential index was 72.5 (11.2). During the first period of unconsciousness it decreased to 39.6 (6.9) and returned to 66.8 (12.5) when patients regained consciousness. Thereafter, similar values were obtained whenever patients lost and regained consciousness. Latencies and amplitudes changed in a similar fashion. From all parameters studied, Na latencies had the greatest overlap between successive awake and asleep states. The auditory evoked potential index and Nb latencies had no overlap. The consistent changes demonstrated suggest that the auditory evoked potential index could be used as a reliable indicator of potential awareness during propofol anaesthesia instead of latencies and amplitudes.     

The use of somtaosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring in a patient with Brugada syndrome

IntroductionWe report on the use of Somastosensory Evoked Potential (SSEP) and Motor Evoked Potential (MEP) monitoring in a patient with Brugada syndrome.ObjectivesThe concern in this case was that the amount of current/voltage generated by SSEP/MEP might trigger arrhythmias in a patient with underlying Brugada syndrome.MethodsA 42 year-old male patient with Brugada syndrome underwent excision of an intramedullary tumour with the use of SSEP and MEP monitoring. Preoperatively, he was not on antiarrhythmic medication, nor had an Implantable Cardioverter Device (ICD) in-situ.ResultsThe patient remained stable & in sinus rhythm throughout the operation and was successfully extubated postoperatively.ConclusionThis case report indicates that SSEP/MEP monitoring may be used in patients with Brugada syndrome.     

Awareness detected by auditory evoked potential monitoring

We report a case of awareness detected by the Alaris AEP Monitor,a device that measures anaesthesia by tracking changes of thewaveform of the mid-latency auditory evoked potential. Br J Anaesth 2003; 91: 290–2     

Motor versus somatosensory evoked potential changes after acute experimental spinal cord injury in rats

Summary In this study, averaged cortical somatosensory evoked potentials (SEP) after sciatic nerve stimulation, and lower extremity muscle responses after motor cortex stimulation (MEP) were compared in rats. 10 animals served as light (25g-cm) and 10 animals as severe (80g-cm) acute spinal cord injury group after weight dropping trauma. After the initial loss of components, both SEP and MEP recovered in most cases in the light injury group. In the severe injury group, however, no recovery was observed in cortical SEPs, while the muscle MEP recovered in some animals. Light spinal cord injury had little effect on muscle MEPs and caused a paradoxical amplitude increase in some MEP recordings. Latency values of muscle MEPs did not show great changes after either kind of injury, while cortical SEP latency was considerably delayed.In this model cortical SEPs were more sensitive to light spinal cord injury than muscle MEPs after single electrical cortical stimuli. Severe spinal cord injury caused amplitude changes or loss of waves from both SEP and MEP.This work was partly presented in the poster sections at 39. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie, Köln (F. R. G., May 8-1, 1988 and Congress of the International Medical Society of Motor Disturbances, Rome, Italy, June 2–4, 1988.     

Studies on corpus cavernosal nerve evoked potential in male diabetic rats

Aim: To observe the cavernosal nerve function in male diabetic rats. Methods: Thirty-five male adult SD rats were divided randomly into the diabetic group (n=15) and the control group (n=10). In the diabetic group, diabetes was produced by the administration of streptozotocin (63 mg/kg) at a single intraperitoneal dosing. The latent period of reaction and the corpus cavernosal smooth muscle myopotential were observed after giving a single stimulus to the corpus cavernosal nerve. Results: Compared with the controls, the diabetic rats had a longer latent period and a higher myopotential (both P<0.01). Conclusion: Corpus cavernosal nerve dysfunction may play a role in the erectile dysfunction of diabetic rats.     

听觉诱发电位指数在麻醉深度监测中的作用

目的观察腹腔镜胆囊切除术(LC)中丙泊酚靶控输注(TCI)或异氟醚吸入维持麻醉期间听觉诱发电位指数(AAI)在麻醉深度监测中的作用。方法33例ASAⅠ级择期行LC的患者,随机分为两组:异氟醚组(I组)18例行诱导插管吸入全麻,丙泊酚组(P组)15例诱导插管同I组;麻醉维持分别用异氟醚与氧化亚氮吸入或丙泊酚靶控输注与氧化亚氮吸入。通过调节异氟醚吸入浓度或丙泊酚靶控输注浓度使麻醉期间MAP、HR波动在基础值±20%范围内,记录麻醉期间异氟醚呼气末浓度、丙泊酚靶控输注浓度及AAI值。结果两组AAI值均较低,P组出现一过性AAI值≤10有12人次,I组则有4人次;且AAI值与丙泊酚靶控输注浓度及异氟醚呼气末浓度呈负相关(P<0.05),与MAP、HR无明显相关。结论结合AAI监测可更全面的反映麻醉深度。     

Effect of renewed SS-cream on spinal somatosensory evoked potential in rabbits

Aim: The effect of a renewed SS-cream (RSSC) on the treatment of premature ejaculation (PE) was evaluated and compared with the original SS-cream (OSSC). Methods: Sixty male white New Zealand rabbits, weighing 2.5kg-3.0 kg, were divided at random into 3 groups: the RSSC, OSSC and placebo groups. The spinal somatosensory evoked potential (SSEP) elicited by electric stimulation of the glans penis with disk electrode was investigated with an electrophysiograph (Poseidomn, Shanghai, China) before and 10, 30 and 60 min after drug or placebo application on the glans. The Onset and the N1 latencies and the amplitude of SSEP were recorded and analyzed. Results: There was no significant difference (P>0.05) in the mean Onset and Nl latency of SSEP among the 3 groups before drug application. Compared with the pre-application value, the mean Onset and Nl latencies in the RSSC and OSSC groups were significantly prolonged at 10, 30 and 60 min after treatment (P<0.05), while they were not significantly changed (P>0.05)     

体感诱发电位在脊柱手术中的监测作用

目的：探讨脊柱外科手术中体感诱发电位监护技术的准确性。方法：对78例颈、胸椎手术患者术中采用皮层体感诱发电位(cortical somatosensory evoked potential，CSEP)术中监测，记录术前、术中、术后各个重要手术步骤的CSEP变化，根据不同阶段诱发电位的变化与术后临床脊髓功能改变相结合，判断CSEP的准确性。结果：78例患者中，CSEP未达到监护界值71例，术后无脊髓损伤；5例患者术中CSEP达到预警标准，告诫手术医生，注意手术操作，术后无脊髓损伤；另外，出现假阳性和假阴性各1例，术后恢复亦良好。结论：排除各种干扰因素后体感诱发电位可较准确地对脊髓的功能状况进行监测，是较准确的脊柱外科手术监护技术。     

颈胸椎手术中体感诱发电位监护的影响因素分析及准确性观察

目的探讨体感诱发电位监护在颈、胸椎手术中的应用价值,对其准确性及影响因素进行分析。方法颈、胸椎疾病患者采用皮层体感诱发电位（CSEP）及皮层下体感诱发电位（Sub-CSEP）术中监测,根据麻醉前、后及不同手术阶段体感诱发电位的变化与术后功能相结合,判断体感诱发电位（SEP）的准确性。结果麻醉因素引起的SEP波幅降低主要影响CSEP,双侧刺激均改变,但基本未达到手术预警标准值,而Sub-SEP变化不明显。手术高危操作侵及脊髓,SEP波幅降低主要影响高危操作的同侧,表现为同侧CSEP及Sub—CSEP波幅同时降低,并且降低幅度较大,达到预警标准值,而对侧CSEP及Sub-CSEP波幅变化不甚明显。其他非手术原因如低体温、局部冷盐水冲洗脊髓,引起SEP潜伏期延长,波幅变化不明显。失血过多致平均动脉压降低可引起SEP波幅降低,潜伏期变化不明显。局部低温及低血压引起的SEP改变,均未达到预警标准值。结论颈、胸椎手术中采用体感诱发电位监测排除各种干扰,可较准确地反映脊髓的生理或病理状况。