摘要
目的:探讨术中神经监测(intraoperative neurophysiological monitoring,IONM)在脊髓手术中的应用。方法:对24例脊髓手术患者,根据监测方法不同分为4组。A组(腹侧肿瘤)行体感诱发电位(somatosensory evokedpotential,SEP)、运动诱发电位(motor evoked potential,MEP)及肌电图(electromyography,EMG)监测;B组(髓内肿瘤)行SEP+MEP监测;C组(髓外硬膜下肿瘤)行SEP+EMG监测;D组(马尾神经病变)行EMG监测,分析术中监测情况与术后神经功能变化之间的关系。结果:A组3例,术中均有监测报警,手术结束前均恢复,但有1例出现术后神经功能恶化。B组6例,术中均有监测报警,手术结束前5例恢复,1例未恢复者术后神经功能恶化。C组9例,其中7例术中监测报警,手术结束前均恢复,但有1例出现术后神经功能恶化。D组6例,术中均有监测报警,手术结束前均恢复,但有1例出现术后神经功能恶化。结论:IONM可及时提醒术者患者的神经系统可能存在功能损伤,从而采取补救措施,有助于减少术后神经功能恶化,但部分患者采取措施后监测虽恢复,仍出现不同程度的神经功能恶化,IONM还需要进一步完善。
Objective：To study application of intraoperative neurophysiological monitoring（IONM） in spinal cord surgery.Methods： In the study,24 patients with spinal cord tumors were divided into 4 groups according to the method of monitoring.Group A（ventral tumors） underwent somatosensory evoked potential（SEP） ＋ motor evoked potential（MEP） ＋ electromyography（EMG） monitoring,group B（intramedullary tumors） underwent SEP ＋ MEP monitoring,group C（subdural extramedullary tumors） underwent SEP ＋ EMG monitoring,group D（conus medullary and cauda equina lesions） underwent EMG monitoring.The relationship between changes of IONM and postoperative neurological function was analyzed.Results： All of the 3 patients in group A had IONM alteration which recovered before the end of surgery,but neurological function deteriorated in 1 case.All of the 6 patients in group B had IONM alteration,of whom 5 recovered before the end of surgery,and 1 did not recover and neurological function deteriorated in this case.Seven of the nine patients in group C had IONM alteration which recovered before the end of surgery,but neurological function deteriorated in 1 case.All of the 6 patients in group D had IONM alteration which recovered before the end of surgery,but neurological function deteriorated in 1 case.Conclusion： IONM is useful to reduce postoperative neurological deterioration.However,IONM neurophysiological monitoring needs further improvement.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2012年第5期776-779,共4页
Journal of Peking University:Health Sciences
关键词
电生理学
脊髓
监测
手术中
脊神经根
Electrophysiology
Spinal cord
Monitoring
intraoperative
Spinal nerve roots
