Amantini A, Bartelli M, de Scisciolo G, Lombardi M, Macucci M, Rossi R, Pratesi C, Pinto F
Department of Neurological and Psychiatric Sciences, University of Florence, Italy.
J Neurol. 1992 May;239(5):241-7. doi: 10.1007/BF00810344.
Somatosensory evoked potentials (SEPs) were monitored in the course of 368 carotid endarterectomies (CEAs) carried out in 312 patients. In an initial group of 26 patients the shunt was used routinely while in a second group, involving 342 CEAs, it was applied selectively on the basis of modifications which the SEP underwent during clamping. The criterion for shunting was the progressive reduction, up to 50%, of the N20-P25 amplitude. New postoperative neurological deficits appeared in 6 patients, all of whom displayed a transitory SEP flattening. The SEPs of 2 of these returned to normal by the time they awoke and both showed a clinical deficit homolateral to the operated side. In only 2 cases did the deficit fail to regress completely and their postoperative CT scans revealed ischaemic lesions. A positive relationship emerged between SEP changes and back pressure values; nonetheless, as many as 75% of the patients with low residual back pressure values (less than 25 mmHg) tolerated the clamping. SEP monitoring appears to provide a reliable basis for selectively applying a shunt when there is a high risk of haemodynamic ischaemia during clamping.
在312例患者所进行的368例颈动脉内膜切除术（CEA）过程中监测体感诱发电位（SEP）。在最初的26例患者组中常规使用分流管，而在第二组（涉及342例CEA）中，根据夹闭期间SEP的变化情况选择性应用分流管。分流的标准是N20-P25波幅逐渐降低达50%。6例患者术后出现新的神经功能缺损，所有这些患者均表现为SEP短暂性平坦。其中2例患者苏醒时SEP恢复正常，且均表现为手术侧同侧的临床缺损。仅2例患者的缺损未完全消退，其术后CT扫描显示有缺血性病变。SEP变化与背压值之间呈现正相关关系；尽管如此，高达75%的残余背压值较低（低于25 mmHg）的患者耐受夹闭。当夹闭期间存在血流动力学缺血的高风险时，SEP监测似乎可为选择性应用分流管提供可靠依据。
