大脑中动脉动脉瘤夹闭术中电生理监测的意义  

Electrophysiological monitoring during intraoperative occlusion of middle cerebral artery aneurysms

作　　者：李文超 周文科[1] 赵锦丽[1] 黄立勇[1] 恵磊 高国军[1] 王磊[1] 金保哲[1] LI Wen-Chao;ZHOU Wen-Ke;ZHAO Jin-Li;HUANG Li-Yong;HUI Lei;GAO Guo-jun;WANG Lei;JIN Bao-zhe(Department of Neurosurgery,Affiliated Hospital,Xinxiang Medical College,Xinxing 453100,China)

机构地区：[1]新乡医学院第一附属医院神经外科,河南新乡453100

出　　处：《中国临床神经外科杂志》2018年第6期405-406,415,共3页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81541030)

摘　　要：目的探讨在术中神经电生理监测下大脑中动脉动脉瘤夹闭术中大脑中动脉临时阻断的安全时限。方法 2016年10月至2017年5月手术夹闭大脑中动脉动脉瘤51例,术中行神经电生理监测评价大脑中动脉临时阻断安全时限。术后均行CT(1~3 d)和CTA(1周内)复查,以阻断血管供血区域出现低密度改变为影像缺血事件;以术后出现阻断血管供血区域神经功能降低(术后有单个或多个肢体肌力与术前相比下降≥1级)为临床缺血事件。结果 51例共56个动脉瘤均完全夹闭。5例(9.8%)术中出现监测指标的变化,其中2例手术结束前恢复至基线水平,另3例经术中干预,直至手术结束,波形未能完全恢复至基线水平,术后出现相关性缺血事件。发生缺血事件的3例术中载瘤动脉临时阻断时间均在8 min以上,而未发生缺血事件的48例均在8 min以下;多因素Logistic回归分析显示术中载瘤动脉临时阻断时间≥8 min是术后发生缺血性事件的独立危险因素(OR=4.190;95%CI:3.937~12.982;P=0.036)。结论本文结果提示大脑中动脉动脉瘤夹闭术中临时阻断大脑中动脉的最长安全时限可能是8 min。Objective To observe the safe time limit of temporary clipping of the middle cerebral artery（MCA） with the intraoperative neurophysiological monitoring. Methods Under normal temperature and atmospheric pressure, intraoperative neurophysiological monitoring was performed in 51 patients with 56 MCA aneurysms undergoing clipping. The duration and the number of temporary clipping of MCA, the changes in the electroencephalographic waves before and after the temporary clipping of MCA and the ischemic events related to the temporary clipping of MCA were observed and the relationship among them analyzed. Results Of 5 patients with ischemic electroencephalographic waveform after the temporary clipping of MCA, 2 had the normal electroencephalographic waveform after the adoption of corresponding measures and 3 still had the ischemic electroencephalographic waveform and a certain degree of limb dysfunction 6 months after the operation. Conclusion It is suggested that the clipping of MCA for shorter than 8 minutes may be safe during the clipping for the MCA aneurysms.

关 键 词：颅内动脉瘤 大脑中动脉 夹闭术 载瘤动脉临时阻断 术中神经电生理检查 安全时限 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]