中耳手术中面神经监测的应用  

Facial nerve monitoring in middle ear surgeries

作　　者：迟放鲁[1] 徐静[2] 顾峻[3] 黄婷[3] 顾瑛[3] 范学萍[3] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳神经颅底外科,上海200031 [2]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031 [3]复旦大学附属眼耳鼻喉科医院手术室,上海200031

出　　处：《中华耳科学杂志》2008年第3期249-252,共4页Chinese Journal of Otology

摘　　要：目的评价术中面神经监测在中耳手术中的作用并系统化其监测方法,探讨全身麻醉对神经监测的影响。方法40例鼓室成形术中应用面神经实时监测,静脉输注罗库溴铵维持50%的肌松程度。根据术中直视下面神经暴露程度,分为面神经暴露组(A组,n=16)和面神经非暴露组(B组,n=24),测定面神经诱发肌电位的电刺激阈值。结果所有病例均成功诱发面神经肌电位反应,且术后面神经功能均未见异常。50%肌松程度下面神经暴露组电刺激阈值为0.15mA±0.07mA(0.07￣0.25mA),面神经非暴露组电刺激阈值为0.53mA±0.21mA(0.20￣1.00mA)。两者比较,差异有统计学意义(P<0.001)。结论中耳手术中面神经监测有助于定位面神经,预警手术操作,避免医源性面神经损伤。定位未暴露的面神经时,可先用0.5mA刺激,再用1.0mA探寻;面神经暴露时,用0.1mA开始刺激。部分神经肌肉阻滞技术可以满足面神经监测的需要。Objective To evaluate and systemize intraoperative facial nerve monitoring（IFNM） in middle ear surgeries and to investigate the effect of general anaesthesia on nerve monitoring. Methods IFNM was performed in 40 patients undergoing tympanoplasty. Rocuronium intravenous infusion was used to control the peripheral neuromuscular blockade at 50%. All the patients were divided into two groups, facial nerve exposure group（group A, n=16） and unexposure group（group B, n = 24）. The electronic stimulating thresholds of facial nerve evoked electromyographic（EEMG） response were recorded. Results All of the patients displayed detectable EEMG responses. The facial nerve function remained well postoperatively. The electronic stimulating thresholds of facial nerve EEMG was 0.15 ± 0.07 mA（0.07 - 0.25 mA）in group A vs. 0.53 ± 0.21 mA（0.20 - 1.00 mA） in group B at the level of NMB = 50%. The significant difference of electronic stimulating thresholds was found between group A and group B（P 〈 0.001）. Conclusions Intraoperative facial electromyographic（EMG） monitoring is a helpful adjunct for surgeon to identify and map the course of the facial nerve, and provide precaution to avoid iatrogenic facial nerve injury. We recommend an electrical stimulation of 0.5 mA for the first screening and 1.0 mA for the second exploration in order to define the facial nerve in middle ear surgery. If the facial nerve is exposed, electrical stimulation should be started from 0.1 mA. Partial neuromuscular blockade could provide reliable conditions for intraoperative facial nerve monitoring

关 键 词：面神经 术中监测 部分神经肌肉阻滞 

分 类 号：R764.92[医药卫生—耳鼻咽喉科] R741.049[医药卫生—临床医学]