脊柱手术中多模式神经电生理监测异常的原因分析及处理对策

Cause analyses and strategies on abnormalities of multimodal intraoperative eletroneurophilogy monitoring in spinal surgery cases

中文关键词:  脊柱手术  神经电生理监测  体感诱发电位  经颅电刺激运动诱发电位  自由肌电图

英文关键词:Spinal surgery  Multimodal intraoperative neurology monitoring  Somatosensory evoked potential  Transcranial electrical stimulation motor evoked potentials  Free-run electromyography

中文摘要:

  【摘要】 目的：分析脊柱手术中影响术中神经电生理监测的因素，总结提高术中神经监测成功率的技术要点。方法：回顾分析476例脊柱手术中使用体感诱发电位（somatosensory evoked potential，SEP）、经颅电刺激运动诱发电位（motor evoked potentials，MEP）、自由肌电图（free-run electromyography，Free-run EMG）多模式联合监测患者的资料，对术中神经监测出现异常改变的患者进行原因分析。结果：76例术中电生理监测发生异常，其中21例患者因术前存在神经功能障碍，8例因手术操作引起神经损伤，7例因肌松药使用不合理，8例因不合理使用吸入麻醉药，3例因患者发生肌颤导致下肢SEP监测异常，4例因电磁场干扰，7例因患者体位摆放不当，7例因电极线连接故障，11例原因不明。其中28例经采取合理干预措施使得神经监测异常得以纠正。结论：对诱发异常的病例应从操作技术、麻醉、电磁场环境、患者因素等多方面逐一分析原因，采取积极有效的措施，以提高监测的成功率。

英文摘要:

  【Abstract】 Objectives: To analyze the causes of the abnormalities in intraoperative eletroneurophilogy monitoring in spinal surgery, and to investigate the strategies for improving the monitoring success rate. Methods: A total of 476 cases of spinal surgery with multimodal intraoperative eletroneurophilogy monitoring, including somatosensory evoked potential(SEP), transcranial electrical stimulation motor evoked potentials(MEP) and free-run electromyography(Free-run EMG), was analyzed retrospectively. Results: Abnormal waveforms were detected in 76 cases. Twenty-one of them had preoperative neurological disorders. Abnormalities in 8 cases were caused by iatrogenic nerve impairment. The other abnormalities were caused by inappropriate use of muscle relaxant(7 cases), inappropriate use of inhaled anesthetics(8 cases), lower limb muscle tremors(3 cases), electromagnetic field interference(4 cases), improper operative position(7 cases), incorrect link of electrode wires(7 cases) and unknown reasons(11 cases) respectively. Among the abnormal cases, twenty-eight returned to normal after effective intervention. Conclusions: Several aspects, including operation technique, anesthesia, electromagnetic environment and patient factors, should be taken into consideration for coping with monitor abnormalities. Positive and effective measures should be taken for better monitoring.