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目的:探讨应用经颅电刺激运动诱发电位(TES-MEP)和皮层体感诱发电位(CSEP)联合监护脊髓型颈椎病(CSM)手术中脊髓功能的护理要点。方法:回顾性分析2012年3月至2014年10月本院行CSM手术同时监测双侧三角肌、肱二头肌、大鱼际肌、小鱼际肌和胫前肌TES-MEP以及双侧正中神经CSEP 196例患者的临床资料,分析术中诱发电位阳性变化的相关因素及术后并发症情况。结果:术中TES-MEP、CSEP、联合监护的成功率分别为95.4%(187/196)、98%(192/196)和99.5%(195/196)。联合监护阳性6例,其中5例与脊髓功能符合,1例不符合,无假阴性。术中诱发电位阳性9次,2次与体位有关,2次与患者体温下降有关,5次与手术操作不当相关。术后神经损伤1例。患者术后无发生皮肤烧灼伤、红肿热痛、舌咬伤等监护并发症。结论:TES-MEP和CSEP联合监护可安全用于颈椎手术做脊髓功能的监测,降低术后皮肤感染发生率,阳性电位能保证及时正确的护理监护。
Objective: To explore the nursing points of spinal cord function in the application of transcranial electrical stimulation of motor evoked potential (TES-MEP) and cortical somatosensory evoked potential (CSEP) in the monitoring of spinal cord function in patients with cervical spondylotic myelopathy (CSM). Methods: From March 2012 to October 2014, we retrospectively analyzed TES-MEP of bilateral deltoid muscle, biceps brachii, major attic muscle, minor turbinate muscle and tibialis anterior muscle at the same time from March 2012 to October 2014 in our hospital. The clinical data of 196 patients with median nerve CSEP were analyzed to analyze the related factors and the postoperative complications of positive evoked potentials during operation. Results: The success rates of TES-MEP, CSEP and combined monitoring were 95.4% (187/196), 98% (192/196) and 99.5% (195/196) respectively. In 6 cases, 5 cases were consistent with spinal cord function, 1 case did not conform to the test, and no false negative. Intraoperative evoked potentials were positive 9 times, 2 times with the body position, 2 times with the patient’s body temperature decreased, 5 times and surgical improperly related. One case of postoperative nerve injury. No postoperative skin burns, swelling and pain, tongue bites and other care complications. Conclusion: The combined monitoring of TES-MEP and CSEP can be safely used for the monitoring of spinal cord function in cervical spine surgery and reduce the incidence of postoperative skin infections. Positive potentials can ensure timely and proper nursing care.