Takaya M, Moritake K, Konishi T, Suwa H, Handa H
No To Shinkei. 1986 Jun;38(6):579-84.
Noninvasive electrophysiological evaluation with sensory evoked potentials would be of clear diagnostic and prognostic value in evaluating comatose patients with stroke or severe head injury. In order to protect the brain from such kinds of insults, barbiturate coma therapy has been employed and its effectiveness has been already established. However, in the barbiturate coma therapy, it is occasionally difficult to distinguish the pharmacological effect of barbiturate from the preexisting brain dysfunction caused by the underlying process of the disease. In adult cats, authors studied changes of sensory evoked potentials following cumulative intravenous administration of thiopental which is used clinically for barbiturate coma therapy. P1 and N1 of cortical SEP showed tendency of gradual decrease in amplitude. However, no significant changes occurred in latency by stepwise increment of thiopental dose. Changes in amplitude of P1 and N1 of cortical SEP preceded to the flattening on electroencephalogram. Around at the level of the concentration where EEG changes began, I-II interpeak latency of BAEP and latency of wave I of short latency SEP started to increase. BAEP and early components of SEP (I.II.III.IV) persisted even in by far the higher level of serum concentration of thiopental than that of clinical use. Furthermore, most of these parameters showed no statistically significant change neither in amplitude nor in latency. These experimental results suggest that sensory evoked potentials will provide us with useful information in the assessment of the brainstem function in patients under thiopental induced deep coma.
利用感觉诱发电位进行无创电生理评估，对于评估中风或严重头部损伤所致昏迷患者具有明确的诊断和预后价值。为了保护大脑免受此类损伤，巴比妥类昏迷疗法已被采用，其有效性也已得到证实。然而，在巴比妥类昏迷疗法中，有时很难区分巴比妥类药物的药理作用与由疾病潜在进程引起的原有脑功能障碍。在成年猫中，作者研究了临床上用于巴比妥类昏迷疗法的硫喷妥钠静脉累积给药后感觉诱发电位的变化。皮质体感诱发电位的P1和N1波幅呈逐渐降低趋势。然而，随着硫喷妥钠剂量逐步增加，潜伏期未见明显变化。皮质体感诱发电位P1和N1波幅的变化先于脑电图的平坦化。在脑电图开始出现变化的浓度水平附近，脑干听觉诱发电位的I-II峰间期和短潜伏期体感诱发电位的I波潜伏期开始增加。即使在硫喷妥钠血清浓度远高于临床使用水平的情况下，脑干听觉诱发电位和体感诱发电位的早期成分（I、II、III、IV）仍持续存在。此外，这些参数中的大多数在波幅和潜伏期方面均未显示出统计学上的显著变化。这些实验结果表明，感觉诱发电位将为我们评估硫喷妥钠诱导深度昏迷患者的脑干功能提供有用信息。
