Neuromonitoring Using Motor and Somatosensory Evoked Potentials in Aortic Surgery
Neuromonitoring Using Motor and Somatosensory Evoked Potentials in Aortic Surgery
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DOI：
10.1111/jocs.12739
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发表时间：
2016-06-01
影响因子：
1.6
通讯作者：
Elefteriades, John A.
中科院分区：
文献类型：
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作者：
Liu, Lucy Y.;Callahan, Brooke;Elefteriades, John A.
背景：运动诱发电位（MEP）和体感诱发电位（SSEP）是预防降腹主动脉或胸腹主动脉修复术后截瘫的常用神经监测方法。然而，它们的预测影响仍然存在争议。本研究的目的是评估我们使用这种监测技术的单中心体验。方法：2009年至2014年间，78例患者（平均年龄66 +/- 12岁，53%男性）行降主动脉或胸腹主动脉修复术。其中，60%为主动脉瘤，30%为夹层，10%为其他病因。术中监测mep和ssep，必要时根据神经监测信号调整临床参数（血压、红细胞压积、氧合）。本分析的重点是在使用术中神经监测后的神经预后（截瘫，中风）。结果：30天死亡率为10例（12.8%）。所有信号持续稳定或信号丢失后恢复的患者均未发生脊髓损伤，而在手术过程中信号丢失（无恢复）的6例可评估患者中有2例发生术后截瘫（1例短暂性截瘫，1例永久性截瘫）。MEP和SSEP对截瘫的敏感性和特异性分别为100%和94.20%。结论：(1)信号保存或信号返回是脊髓功能预后的良好指标。(2)术中直接响应信号变化的修改可能避免了无神经损伤的信号丧失患者的永久性瘫痪。我们发现MEP和SSEP神经监测有助于预防截瘫。
Background: Motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) are established methods of neuromonitoring aimed at preventing paraplegia after descending or thoracoabdominal aortic repair. However, their predictive impact remains controversial. The aim of this study was to evaluate our single-center experience using this monitoring technique. Methods: Between 2009 and 2014, 78 patients (mean age 66 +/- 12, 53% male) underwent either descending or thoracoabdominal aortic repairs. Of these, 60% had an aortic aneurysm, 30% dissection, and 10% other etiologies. Intraoperatively, MEPs and SSEPs were monitored and, if necessary, clinical parameters (blood pressure, hematocrit, oxygenation) were adjusted in response to neuromonitoring signals. This analysis is focused on the neurological outcome (paraplegia, stroke) after the use of intraoperative neuromonitoring. Results: Thirty-day mortality was 10 (12.8%). All patients with continuously stable signals or signals that returned after signal loss developed no spinal cord injury, whereas two out of six of the evaluable patients with signal loss (without return) during the procedure suffered from postoperative paraplegia (one transient and one permanent). Sensitivity and specificity of use of MEP and SSEP were 100% and 94.20% regarding paraplegia, respectively. Conclusions: (1) Preservation of signals or return of signals is an excellent prognostic indicator for spinal cord function. (2) Intraoperative modifications in direct response to the signal change may have averted permanent paralysis in the patients with signal loss without neurologic injury. We have found MEP and SSEP neuromonitoring to be instrumental in the prevention of paraplegia.