目的 探讨颈动脉残端压(SP)联合电生理监测在颈动脉内膜切除术(CEA)中的应用价值。方法 回顾性分析19例CEA患者临床资料,通过监测SP、体感诱发电位(SEP)和运动诱发电位(MEP),以确定术中是否放置转流管;比较术前和术后6月美国国立卫生院卒中量表(NIHSS)评分和改良Rankin量表(mRS)评分变化情况。结果 10例患者SP≥50mmHg,SEP和MEP监测无异常,术中未放置转流管;5例患者SP<50 mmHg,SEP波幅下降>50％,MEP监测正常,予以放置转流管;3例患者SP≥50 mmHg,SEP波幅下降>50％,MEP监测正常,予以放置转流管;1例患者SP>50 mmHg,SEP监测正常,MEP波幅下降>50％,未放置转流管。所有患者手术均获得成功,无手术死亡率。患者术后6月NIHSS评分和术前无统计学差异(P>0.05),但术后6月mRS评分较术前下降(P<0.05)。结论 通过术中SP、SEP和MEP联合监测,有助于避免CEA术后缺血性脑卒中的发生,提高CEA手术的安全性。

Objective To investigate the value of stamp pressure(SP), somatosensory and motor evoked potentials(SEP,MEP) monitoring in carotid endarterectomy. Methods 19 patients with carotid endarterectomy were retrospectively analyzed.SP, SEP and MEP were monitored during the operation.National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were used to evaluate the neurological function before and 6 months after surgery. Results Intraluminal shunting was not performed in 10 patients with normal SP, SEP and MEP.However, intraluminal shunting technique was used in 5 patients (SP<50 mmHg and SEP fluctuation decreased by 50％) and 3 patients (SP≥50 mmHg and SEP fluctuation decreased by 50％).1 patient showed the fluctuation of MEP decreased by 50％, while SP and SEP was normal, no shunting was performed.All patients were successfully operated, and no mortality occurred.The mRS score, not the NIHSS score, revealed statistically difference between preoperation and 6 months after surgery (P<0.05). Conclusion The combination of SP, SEP and MEP monitoring maybe useful for preventing ischemic stroke after carotid endarterectomy, increasing the safety of surgery.