正中神经脑干躯体感觉诱发电位和经颅短串电刺激运动诱发电位联合术中监护在颈髓手术中的应用

目的研究在异丙酚全静脉麻醉方案下,联合应用正中神经脑干躯体感觉诱发电位(MN-BSEP)和经颅短串电刺激运动诱发电位(STTES-MEP)对颈髓手术实施术中监护的可行性。方法通过变换不同的刺激条件、记录条件、技术参数,分别摸索MN-BSEP和STTES-MEP的可靠检测方法,并按照总结得到的技术规范,选择我科15例接受颈髓手术的病人,进行术中联合监护,对照分析术前和术后脊髓功能的改变和诱发电位变化之间的关系。结果MN-BSEP基本不受麻醉影响,术后的改变与术后病人感觉功能的转归情况相吻合;STTES-MEP与麻醉方案有关,在异丙酚麻醉下,可记录到清晰、稳定的运动诱发电位,其术后的变化与术后病人肌力的转归情况相吻合。结论选用异丙酚全静脉麻醉,联合应用MN-BSEP和STTES-MEP实现对颈髓功能的术中监护是可行的,其效果优于单纯应用体感诱发电位或运动诱发电位进行监护。

Study on combined monitoring in cervical cord operation by median nerve brainstem somatosensory evoked potential (MN-BSEP) and short train transcranial electrical stimulation motor evoked potential (STTES-MEP)

Objectives To study the feasibility of combined monitoring in cervical cord operation by MN-BSEP and STTES-MEP under propofol intravenous anesthesia. Methods The technique of MN-BSEP and STTES-MEP by changing the parameter of stimulate and register was studied first, then 15 patients who went through cervical cord operation were intraoperatively monitored, the relationships between the change of the evoked potential and function of the cervical cord were studied. Results The type of anesthesia has no influence on MN-BSEP but on STTES-MEP. The changes of MN-BSEP and STTES-MEP have something to do with the change of sensory and motor function. Conclusions Satisfactory cervical cord monitoring can be achieved using MN-BSEP together with STTES-MEP under propofol intravenous anesthesia. The effect of combined monitoring is better than using only one technique.