【摘要】 目的 :研究围脑干手术中体感诱发电位 (SEP)神经生理监测与HR监测的关系。方法 :选择 43例全凭静脉麻醉的围脑干手术病例 ,对两侧正中神经分别进行刺激 ,记录相应SEP的N2 0 波形 ,术中N2 0 发生明显变化 (潜伏期延长超过 1ms或波幅降低超过 5 0 % ) ,即通知术者调整操作 ,HR出现突然而明显的变化也及时通知术者。结果 :3例术后出现神经病损者术中SEP均表现为持续抑制 ,而其中 1例HR并没有明显变化。术中SEP变化与HR改变的发生率并无差别 ,两者之间相关性也不明显 (P >0 0 5 )。结论 :用于监测围脑干手术 ,SEP比HR的变化更客观可靠。由于两者各反映了脑干中两种不同神经结构的功能状态 ,将其结合起来进行监测是很有意义的。目的 :研究围脑干手术中体感诱发电位 (SEP)神经生理监测与HR监测的关系。方法 :选择 43例全凭静脉麻醉的围脑干手术病例 ,对两侧正中神经分别进行刺激 ,记录相应SEP的N2 0 波形 ,术中N2 0 发生明显变化 (潜伏期延长超过 1ms或波幅降低超过 5 0 % ) ,即通知术者调整操作 ,HR出现突然而明显的变化也及时通知术者。结果 :3例术后出现神经病损者术中SEP均表现为持续抑制 ,而其中 1例HR并没有明显变化。术中SEP变化与HR改变的发生率并无差别 ,两者之间相关性也不明显 (P >0 0 5 )。结论更多还原

【Abstract】 Objective:To study the relationship between somatosensory evoked potential(SEP) and changes of heart rate in neurosurgery around the brain stem.Methods:In 43 selective operations around the brain stem,SEP N 20 waveforms were recorded after stimulation of left and right median nerves respectively.Anesthesia was maintained with intravenous anesthetics throughout the operation.As soon as N 20 waveform changed significantly (latency increased more than 1 ms or/and amplitude decreased more than 50% baseline),the surgeon was informed and the operative procedure was modified whenever possible.Apparent and sudden changes of heart rate during surgical procedures around the brain stem were also regarded as “warning criteria”,and the surgeon was informed too.Results:SEP waveforms were all inhibited permanently in 3 patients who had neurologic deficits postoperatively,but there was no apparent change of heart rate in 1 case of these patients.The correlation between SEP and changes of heart rate was not significant ( P> 0 05),and there was no difference between the incidences of them.Conclusion:SEP is more objective and reliable than changes of heart rate for intraoperative monitoring during surgical procedures around the brain stem.Because they reflect the functional states of two different neural structures of the brain stem respectively,it is highly helpful to combine these two methods during intraoperative monitoring for preventing postoperative neurological complications.更多还原