神经电生理监测鉴别心电信息伪差的应用分析  

Application of Intraoperative Neuro Physiological Monitoring to Identify Interference Caused by Expansion of Cardiac Electrical Activity

作　　者：林红 陈晓东[3] 夏鹰[3] 刘亦恒[2] 张小明[2] 张寿[2] 陈漠水[4] 詹莉[4] LIN Hong;CHEN Xiaodong;XIA Ying;LIU Yiheng;ZHANG Xiaoming;ZHANG Shou;CHEN Moshui;ZHAN Li(Department of Functional Diagnostics Haikou Hospital Affiliated to Xiangya School of Medicine,Central South University,Haikou 570208,China;Department of Orthopedics Haikou Hospital Affiliated to Xiangya School of Medicine,Central South University,Haikou 570208,China;Department of Neurosurgery Haikou Hospital Affiliated to Xiangya School of Medicine,Central South University,Haikou 570208,China;Department of Cardiovascular Medicine Haikou Hospital Affiliated to Xiangya School of Medicine,Central South University,Haikou 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院功能诊断科,海口570208 [2]中南大学湘雅医学院附属海口医院骨科,海口570208 [3]中南大学湘雅医学院附属海口医院神经外科,海口570208 [4]中南大学湘雅医学院附属海口医院心血管内科,海口570208

出　　处：《中国医疗设备》2020年第S01期176-180,共5页China Medical Devices

基　　金：海南省卫健委科研项目(1601320113A2001)。

摘　　要：目的探讨手术中运用神经电生理监测(Intraoperative Neuro Electro Physiological Monitoring,IONM)时,联合心电监护,排查因心脏电活动扩布所致的记录波形,减少对监测图形误判,从而提高诊疗质量的临床应用。方法回顾性分析2017年5月至2020年6月在中南大学湘雅医学院附属海口医院运用IONM的病例151例,并实时联合心电监护共同干预,其IONM记录图形中考虑有心脏电活动扩布的波形,观察术中、术后患者的生命体征和中枢性、脊髓的、根性等神经功能的状态,评价IONM记录波形与心电监护仪上心电图的关联,判断IONM结果的真、假阳(阴)性,并进行统计学分析。结果151例IONM同步联合运用心电监护的患者术中,发现有持续的EMG自发电位波群与心电图波群同步出现,敏感性100%,特异性100%,术中判读并结合临床情况未作预警。术后随访一周没有新发现的功能障碍或较术前症状加重。术后随访一月仍没有新发现的功能障碍,较术前症状缓解。阴性预测值100%,约登指数为1。结论术中IONM联合心电监护,鉴别出心脏电活动扩布的波形,排除干扰,有效矫正IONM结果,能够提高术中的监测质量。Objective To explore the clinical application of intraoperative neuroelectrophysiological monitoring(IONM)in surgery,combined with Electrocardiogram monitoring,that identificated the recording waveform caused by the expansion of cardiac electrical activity,and reduced the misjudgment of monitoring patterns,and so improved the quality of diagnosis and treatment.Methods From May 2017 to June 2020,151 cases of Intraoperative neuroelectrophysiological monitoring combined with Electrocardiogram monitoring in surgery were implemented in Central South University Xiangya School of Medicine Affiliated Haikou Hospital.IONM recording waveform was analyzed to cause by the expansion of cardiac electrical activity.The vital signs signs of the patients during and after surgery was observed,and the state of the state of nerve function such as central nervous system,spinal cord,nerve roots,and nerve branches too.The correlation between the IONM record-ing waveform and ECG on the monitor was evaluated.the true and false positive of IONM results were judged,the egative results are also.The statistical analysis was next.Results In 151 patients of IONM combined with Electrocardiogram monitoring,the continuous eEMG self-generated wave was found,which was synchronous with ECG,with sensitivity of 100%and specificity of 100%.The intraope-rative interpretation of IONM recording waveform combined with the patient's clinical condition,the early warning wasn’t provided.There were no newly discovered dysfunctions or aggravation of preoperative symptoms after one week of follow-up.There was no newly discovered dysfunction after one month of follow-up,which was relieved compared with preoperative symptoms.The statistical results:Negative predictive value of 100%,Yoden index of 1.Conclusion Through IONM combined with Electrocardiogram monitoring in surgery,the waveform of cardiac electrical activity expansion is identified,interference is eliminated,and IONM results are effectively corrected,which can improve the quality of intraoperative moni

关 键 词：神经电生理监测 心电监护 矫正监测波形伪差 

分 类 号：R741.044[医药卫生—神经病学与精神病学]