颈动脉内膜切除术中体感诱发电位与经颅多普勒超声监测脑灌注的对比研究

摘要

Objective To investigate the effectiveness of somatosensory evoked potential ( SEP) monitoring in monitoring cerebral perfusion during carotid endarterectomy ( CEA ) .Methods The clinical data of 59 consecutive patients who underwent carotid endarterectomy in our hospital from September 2013 to December 2016 were analyzed retrospectively .All patients were monitored by transcranial doppler ultrasonography ( TCD ) and SEP for changes of cerebral blood flow .The monitoring of TCD defaults to "the gold standard" for comparing results of different time points .By drawing the four-fold table ,calculating the sensitivity ,specificity ,positive predictive value ,negative predictive value of SEP monitoring , the correlation analysis were made between SEP and TCD .In addition,the monitoring Threshold of cerebral hypoperfusion was predicted through ROC curves . Results The sensitivity , specificity , positive predictive value , negative predictive value of SEP amplitude decline beyond 50% in predicting intraoperative cerebral hypoperfusion were 60 .00%, 91.84%, 60% and 91.84%.The diagnostic coincidence rate was 86.44%.The sensitivity, specificity,positive predictive value ,negative predictive value of SEP prolonged latent phase beyond 10%in predicting intraoperative cerebral hypoperfusion were 70.00%,93.88%,70.00%and 93.88%.The diagnostic coincidence rate was 89 .83%.Conclusions Somatosensory evoked potentials can real-time monitor cerebral blood flow continuously in carotid endarterectomy and predict intraoperative cerebral hypoperfusion .In addition, SEP can combine TCD monitoring for carotid endarterectomy cerebral blood flow monitoring or monitor cerebral perfusion alone .%目的 探讨体感诱发电位(SEP)在颈动脉内膜切除术中监测脑灌注状况的效果.方法 回顾性分析2013年9月~2016年12月行颈动脉内膜切除术后出院的59例患者,患者术中均采用经颅多普勒超声(TCD)和SEP联合监测.将术中TCD监测的脑血流状况设为"金标准",在不同的监测时间点,记录两种方法的监测值.通过四格表法计算SEP监测脑灌注不足的敏感度、特异度、阳性预测值和阴性预测值;并将SEP与TCD的监测数值进行相关性分析,综合评价前者在颈动脉内膜切除术中监测脑灌注状况的准确性.另外,通过绘制ROC曲线,寻找预测术中脑灌注不足的最佳SEP监测阈值.结果 SEP波幅下降>50%预测术中脑灌注不足的敏感性、特异性、阳性预测值和阴性预测值分别为60.00%、91.84%、60.00%、91.84%,诊断符合率为86.44%.SEP潜伏期延长>10%预测术中脑灌注不足的敏感性、特异性、阳性预测值和阴性预测值分别为70.00%、93.88%、70.00%、93.88%,诊断符合率为89.83%.结论 SEP可以在颈动脉内膜切除术中连续、实时地进行脑血流监测,能较好地预测术中脑灌注不足;可以和TCD等监测手段共同使用,或单独应用于颈动脉内膜切除术中的脑血流监测.