Assessment of intraoperative motor evoked potentials for predicting postoperative paraplegia in thoracic and thoracoabdominal aortic aneurysm repair
Assessment of intraoperative motor evoked potentials for predicting postoperative paraplegia in thoracic and thoracoabdominal aortic aneurysm repair
复制标题
术中运动诱发电位评估预测胸腹主动脉瘤修复术后截瘫
作者：
T. Horiuchi;M. Kawaguchi;S. Inoue;Hironobu Hayashi;R. Abé;N. Tabayashi;S. Taniguchi;H. Furuya
目的运动诱发电位（MEP）监测是主动脉修复术中检测脊髓缺血的可靠方法。然而，关于MEP预测术后截瘫的敏感性和特异性的数据有限。我们回顾性评估的价值，术中MEP振幅预测术后parapleg.MethodsThe病历的44例患者进行了审查。对C3-C4进行五串刺激，并记录拇短展肌和胫骨前肌的MEP。检测SCI的截止点设定为基线MEP下降75%。受试者工作特征曲线应用于不同的cutups.Results3例（6.8%）术后截瘫。术中最小MEP预测截瘫的敏感性为100%，特异性为64.9%，手术结束时MEP预测截瘫的敏感性为66.7%，特异性为78.0%：仅1例边缘性截瘫（右侧单瘫）患者显示假阴性结果。受试者工作特征曲线表明，适当的截断点为最小MEP在手术期间和MEP振幅在手术结束时分别为75-90%下降和64-75%下降的基线MEP，respectively.ConclusionMonitoring MEP具有相对较高的敏感性和可接受的特异性，与截断点设置为75%下降的基线MEP，用于预测截瘫和轻瘫。由于我们研究的样本量较小，需要进一步的研究来确定预测术后截瘫的适当临界点。
PurposeMonitoring motor evoked potentials (MEPs) has been recognized as a highly reliable method to detect intraoperative spinal cord ischemia (SCI) in aortic repair. However, the data regarding the sensitivity and specificity of MEPs for predicting postoperative paraplegia are limited. We retrospectively assessed the value of intraoperative MEP amplitudes for predicting postoperative paraplegia.MethodsThe medical records of 44 patients were reviewed. A train-of-five stimulation was delivered to C3–C4, and MEPs were recorded from the abductor pollicis brevis and the tibialis anterior muscles. The cutoff point for detecting SCI was set at 75% decrease of the baseline MEP. Receiver operating characteristic curves were applied at various cutoff points.ResultsThree patients (6.8%) had postoperative paraplegia. The minimum MEP during surgery had 100% sensitivity and 64.9% specificity in predicting paraplegia, and the MEP at the end of surgery had 66.7% sensitivity and 78.0% specificity in predicting paraplegia: only 1 patient, who had borderline paraplegia (right monoparesis), showed a false-negative result. Receiver operating characteristic curves indicated that adequate cutoff points for the minimum MEP during surgery and for the MEP amplitude at the end of surgery were a 75–90% decrease and a 64–75% decrease of the baseline MEP, respectively.ConclusionMonitoring MEPs had relatively high sensitivity and acceptable specificity, with the cutoff point set at 75% decrease of the baseline MEP, for predicting paraplegia and paraparesis. Because of the small sample in our study, further investigations would be necessary to investigate an adequate cutoff point that could predict postoperative paraplegia.
DOI：
10.1016/j.jtcvs.2007.11.002
发表时间：
2008-02-01
影响因子：
6
作者：
Etz, Christian D.;Luehr, Maximilian;Griepp, Randall B.
通讯作者：
Griepp, Randall B.