单纯提高平均动脉压可恢复术中神经监测损失的 20%。

Raising Mean Arterial Pressure Alone Restores 20% of Intraoperative Neuromonitoring Losses.

机构信息

Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.

Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.

出版信息

Spine (Phila Pa 1976). 2018 Jul 1;43(13):890-894. doi: 10.1097/BRS.0000000000002461.

DOI:10.1097/BRS.0000000000002461

PMID:29049087

Abstract

STUDY DESIGN

Multicenter prospective.

OBJECTIVE

To assess the effect of intraoperative interventions in restoring intraoperative neuromonitoring (IONM) signals in pediatric spine surgery.

SUMMARY OF BACKGROUND DATA

No prior studies have prospectively examined the rate of return of IONM signals by increasing blood pressure (BP) alone.

METHODS

Patients undergoing posterior spinal deformity surgery were enrolled at their preoperative appointment. Surgeons completed an intraoperative data form on patients who experienced an IONM change defined as a 50% or greater decrease in either transcranial motor evoked potentials or somatosensory evoked potentials.

RESULTS

Four hundred fifty two patients were enrolled with 30 (7%) having IONM change. Thirty patients met inclusion criteria (mean age, 12 yrs, range, 5-19) and had the following diagnoses: idiopathic scoliosis (43%), neuromuscular scoliosis (13%), congenital scoliosis (10%), early onset scoliosis (7%), and other (27%). 20% (6/30) had return of signals due to an increase in BP alone with no other interventions (mean arterial pressure [MAP] increased from mean of 68 [range, 58-76] to 86 mmHg [range, 75-95]). Signals returned to baseline after mean of 16 minutes (range, 2-45). In 60% of patients (18/30), MAP was raised from a mean of 72 mmHg (range, 55-84) to 86 mmHg (range, 75-100) in conjunction with other interventions and had mean return of signals in 37 minutes (range, 8-210). Six (20%) of patients had signals return to baseline after a mean of 6 minutes (range, 3-13) in which MAP did not change appreciably. All patients had return of signals at the conclusion of the procedure with one patient having postoperative neurological sequale.

CONCLUSION

In this prospective study of 452 pediatric spinal deformity surgeries, raising MAPs above 85 mmHg should be considered the first step in response to IONM signal changes, as this alone was successful in 20% of patients without sacrificing deformity correction.

LEVEL OF EVIDENCE

摘要

研究设计

多中心前瞻性研究。

目的

评估术中干预对小儿脊柱手术中术中神经监测（IONM）信号恢复的影响。

背景资料概要

没有先前的研究前瞻性地检查仅通过增加血压（BP）来恢复 IONM 信号的比率。

方法

在术前预约时，招募接受后路脊柱畸形手术的患者。外科医生在遇到 IONM 变化的患者（定义为颅外运动诱发电位或体感诱发电位降低 50%或更多）时，填写一份术中数据表。

结果

共纳入 452 例患者，其中 30 例（7%）出现 IONM 变化。30 例患者符合纳入标准（平均年龄 12 岁，范围 5-19 岁），并具有以下诊断：特发性脊柱侧凸（43%）、神经肌肉性脊柱侧凸（13%）、先天性脊柱侧凸（10%）、早发性脊柱侧凸（7%）和其他（27%）。20%（6/30）的患者信号因单纯增加 BP 而恢复，无其他干预措施（平均动脉压[MAP]从平均 68[范围 58-76]mmHg 增加至 86mmHg[范围 75-95]）。信号在 16 分钟（范围 2-45）后恢复至基线。在 60%的患者（18/30）中，MAP 从平均 72mmHg（范围 55-84）升高至 86mmHg（范围 75-100）mmHg，并联合其他干预措施，信号平均在 37 分钟（范围 8-210）内恢复。6 名（20%）患者的 MAP 无明显变化，信号平均在 6 分钟（范围 3-13）后恢复至基线。所有患者在手术结束时信号均恢复，1 例患者术后出现神经后遗症。