CNIM, San Francisco, CA, USA.
DABNM, Division of Operating Rooms, University of California San Francisco, San Francisco, CA, USA.
J Clin Monit Comput. 2020 Feb;34(1):131-137. doi: 10.1007/s10877-019-00272-5. Epub 2019 Feb 6.
Jasiukaitis and Lyon (J Clin Monit Comput, https://doi.org/10.1007/s10877-018-0181-9, 2018) described an motor evoked potential (MEP)amplitude trending system to detect MEP amplitude loss against a background of MEP variability. They found that the end of case value of a running R triggered by a set MEP amplitude loss criterion appeared to discriminate new injury from non-injury in a small sample of three patients. The present study examines the predictive capability of the running R in a larger sample of patients (21 injured and 19 non-injured). It also varies the amplitude loss criterion (50%, 65% and 80%) for triggering the running R and the numbers of points used in the moving linear regression (8, 12 and 16). 40 patients who had undergone correction for lumbar deformity were retrospectively examined. 21 of these woke up with a newly acquired radicular injury, 19 did not but were characterized by hypovolemic hemorrhage. All 40 patients had sufficient MEP amplitude loss sometime during their procedure to cause the monitoring specialist to report this to the surgeon and anesthesia. End-of-case running Rs were significantly larger in the injury group. Using an 80% amplitude loss criterion to trigger the running R proved to be too stringent, causing reduced sensitivity. The running R appeared to have equivalent sensitivity to that of conventional MEP amplitude loss ratios, but superior specificity within this monitoring challenged sample. The different number of points for the moving regressions did not have any significant effect. End-of-case R values greater than 60% appeared to be highly predictive of new post-operative deficit, while values less than 40% appeared to insure no new deficit. The proposed trending system can discriminate injury from non-injury outcomes when compressive radicular injury during correction for lumbar deformity is involved. This discrimination appears to be successful even when MEP amplitude loss for non-iatrogenic reasons (i.e., hemorrhage) is also occurring.
贾苏凯特蒂斯和莱昂（J Clin Monit Comput，https://doi.org/10.1007/s10877-018-0181-9，2018）描述了一种运动诱发电位（MEP）振幅趋势系统，用于检测 MEP 振幅损失与 MEP 变异性背景下的损失。他们发现，在三个小样本患者中，针对设定的 MEP 振幅损失标准触发的运行 R 的结束案例值似乎可以区分新的损伤与非损伤。本研究在更大的患者样本（21 例受伤和 19 例未受伤）中检查了运行 R 的预测能力。它还改变了触发运行 R 的振幅损失标准（50%、65%和 80%）和移动线性回归中使用的点数（8、12 和 16）。对 40 例接受腰椎畸形矫正的患者进行了回顾性检查。其中 21 例术后新出现神经根损伤，19 例无，但表现为低血容量性出血。所有 40 例患者在手术过程中都有足够的 MEP 振幅损失，导致监测专家向外科医生和麻醉师报告。损伤组的结束案例运行 R 明显更大。使用 80%的振幅损失标准来触发运行 R 被证明过于严格，导致敏感性降低。运行 R 在这种监测挑战样本中似乎与传统的 MEP 振幅损失比具有同等的敏感性，但特异性更高。移动回归中使用的点数不同没有任何显著影响。结束案例 R 值大于 60%似乎高度预测新的术后缺陷，而值小于 40%似乎可确保没有新的缺陷。当涉及腰椎畸形矫正期间的压迫性神经根损伤时，提出的趋势系统可以区分损伤与非损伤结果。即使在非医源性原因（即出血）也发生 MEP 振幅损失的情况下，这种区分似乎也是成功的。
