脊柱侧凸矫形术中体感诱发电位的监测及其临床意义

目的:探讨脊柱侧凸矫形术中体感诱发电位(somatosensory evoked potentials,SEPs)的监测及其临床意义.方法:2001年8月至2002年3月在本院施行矫形手术的青少年脊柱侧凸患者36例,用日本光电MEB2200型诱发电位监测仪在麻醉前、诱导后、插管后、脊柱手术野暴露后及术中进行SEP连续监测.观察手术、麻醉事件对SEP潜伏期及波幅的影响.结果:与SEP改变相关的麻醉事件有芬太尼的单次推注和系统血压的降低,手术事件有钩及棒的植入、撑开、去旋转矫形和节段血管结扎等.结论:采用静脉复合麻醉或静吸复合麻醉可获得有效的麻醉深度和成功监测SEP.手术事件中导致脊髓的震荡、牵拉、平移、旋转以及一过性缺血者均可引起SEP的改变.

Surveillance of somatosensory evoked potentials during scoliosis correction surgery

Objective:To study the surveillance of somatosensory evoked potentials(SEPs) and its significance. Methods: From August 2001 to March 2002,36 adolescent idiopathic scoliosis patients were operated on for their spine deformity in this hospital. SEP were continuously monitored peri operatively.The latency and amplitude of SEP were recorded before anaesthesia, after abduction,after intubation of the spine and during the operation.The correlation of the latency and amplitude of the SEP with operation maneuvers and anaesthesia events were analyzed. Results: The injection of fentanyl and decrease of MAP were found to be correlated with the latency and decrease of SEP amplitude. The operation events correlated with SEP were the installing of hooks and rods, the distraction and derotation correction and segmental blood vessel ligation. Conclusion: Combined intravenous anaesthesia or combined intravenous and inhalation anesthesia are effective to achieve anesthesia levels and to monitor SEP. The concussion, distraction, translation and rotation of the spinal cord and transient ischemia may cause the restrain of the SEP.