关键词: 颈动脉内膜切除术; 躯体感觉诱发电位; 监测

Abstract:

Objective To investigate the value of somatosensory evoked potential(SEP) monitoring in carotid endarterectomy(CEA). Methods Ten patients who underwent CEA for carotid atherosclerosis were retrospectively analyzed in Guangzhou First People's Hospital from January 2010 to January 2012. Carotid artery stump pressure(SP) was measured and the placement of intraluminal shunt was determined by the changes of the N20 in SEP and its latent time monitored during the operation. Their neurological function before and 6 months after surgery were evaluated with modified Rankin Scale(mRS), National Institutes of Health Stroke Scale(NIHSS) and the severity of diameter stenosis. Results Out of 10 patients, in 5 patients the fluctuation was decreased by 50%, stump pressure was less than 50 mmHg, and intraluminal shunt technique was used; in 3 patients the fluctuation was decreased by 50%, stump pressure was more than 50 mmHg, and intraluminal shunt technique was also adopted; in 2 patients few changes in the fluctuation occurred, stump pressure was more than 50 mmHg, and intraluminal shunt technique was not performed. All patients successfully underwent the operation, and no mortality occurred. There was statistical difference in the mRS score between pre-operation and 6 months after surgery(1[quartile 0.5-1.5] vs 2[quartile 1-2.5], P=0.03). There was no significant difference in the NIHSS score(P=0.06). Compared with that of pre-procedure(87.5±8.6)%, the residual stenosis after surgery was significantly improved(6.8±2.5)%(P<0.001).

Conclusion SEP monitoring may be useful for preventing neurologic deficit after CEA. CEA with SEP monitoring may be relatively safe and effective.

Key words: Endarterectomy; Carotid; Somatosensory evoked potential;; Monitoring