SEP监测在甲基泼尼松龙防治脊髓损伤中的作用

【摘要】  目的 探讨脊柱手术中体感诱发电位（SEP）监测脊髓功能在指导甲基泼尼松龙(MP)大剂量冲击治疗脊髓损伤中的价值。方法 颈、胸椎手术病人280例，术前SEP正常术中SEP变化未达到预警标准168例。术前SEP异常术中SEP变化未达到预警标准80例，分为两组，A1组40例术中应用大剂量MP冲击疗法，B1组40例应用甘露醇和地塞米松常规治疗，观察两组早期脊髓功能改善情况。SEP术中达到预警标准32例分为两组：A2组22例治疗同A1组，B2组10例治疗同B1组，观察两组早期脊髓功能改善情况。结果 SEP术中未达到预警标准术前无SEP异常者168例，术后无脊髓损伤症状。A1组与B1组比较，神经症状改善情况无显著统计学差异。A2组与B2组比较，神经症状改善情况有显著性差异（P=0.005）。结论 SEP术中监测达到预警标准，高度怀疑脊髓受到损伤时，及时应用大剂量MP可有效防治脊髓继发性损伤的发生、发展，促进脊髓功能恢复。而对已有的脊髓慢性损伤，术前SEP异常，但术中SEP监测未达到预警标准，应用MP冲击治疗效果欠佳。 
【关键词】  诱发电位 躯体感觉 脊髓损伤 甲基泼尼松龙 治疗结果
　　［ABSTRACT］ Objective To evaluate the clinical value of somatosensory evoked potential (SEP) in monitoring the function of spinal cord and guiding the use of methylprednisolone pulse therapy during surgery for spinal cord injury. Methods Among 280 cases of cervical and thoracic operation, 168  showed normal SEP preoperatively but the changes did not reached the precaution standard at surgery, 80 showed abnormal SEP preoperatively and the changes of SEP at operation did not reached the precaution standard. The latter 80 cases were evenly divided into two groups:  group A1, treated with methylprednisolone pulse therapy; group B1, received routine treatment with mannitol and dexamethasone. For those 32 cases which reached the precaution standard at operation were divided into two groups: group A2 (22 cases) and group B2 (10). Group A2 got the same therapy as group A1, group B2 received the same therapy as group B1. The early?stage improvement of spinal cord function of the above four groups was observed. Results For 168 cases with normal preoperative SEP but did not reached the precaution standard value of SEP at operation showed no symptoms of spinal cord injury. There was no significant differences between group A1 and group B1 in terms of the improvement of neurological symptoms; while the differences between group A2 and  group B2 were statistically different (P=0.005). Conclusion When SEP reached presentiment standard, which highly suggested spinal cord injury, high dose of methylprednisolone should be given to prevent further spinal cord injury and promote the recovery of spinal cord function. For those with chronic injury, suggestive of abnormal preoperative SEP and lower?than?presentiment standard SEP at operation, methypredinisolone pulse therapy is below the mark.
    ［KEY WORDS］  Evoked potentials, somatosensory; Spinal cord injuries; Methylprednisolone; Treatment outcome
    自1978年ENGLER等[1]首先报道体感诱发电位（SEP）在脊柱手术中的监护作用以来， SEP已广泛地应用于各种与脊柱相关疾病的术中监护[2]，SEP监测对反映术中脊髓是否损伤有重要意义。而甲基泼尼松龙(MP)大剂量冲击治疗急性脊髓损伤的效果已被临床证实[3～5]。本研究使用SEP术中监测脊髓功能，旨在评价根据SEP监测结果指导术中应用大剂量MP冲击治疗防治脊髓损伤的价值。现将结果报告如下。