神经电生理检测在急诊机械取栓中的应用  

Application of neuroelectrophysiological monitoring in emergency mechanical thrombus removal

作　　者：王帆[1] 王金川[1] 胡伟鹏[1] WANG Fan;WANG Jinchuan;HU Weipeng(Department of Neurosurgery,the Second Affiliated Hospital of Fujian Medical University,Quanzhou,361000,China)

机构地区：[1]福建医科大学附属第二医院神经外科,福建泉州361000

出　　处：《中国现代医生》2021年第3期85-87,F0003,共4页China Modern Doctor

基　　金：福建省自然科学基金项目(2018J01281);福建省泉州市科技局项目(2019C026R)。

摘　　要：目的探讨神经电生理监测在急诊血管闭塞后机械取栓中的应用。方法回顾性分析2019年8月至2020年4月福建医科大学附属第二医院神经外科患者30例;年龄56~89岁,平均(68.00±9.82)岁;其中颈内动脉闭塞15例,大脑前动脉闭塞8例,大脑中动脉闭塞7例。所有患者均为血管闭塞后,于急诊通过机械支架取栓技术,在神经电生理监测下行动脉闭塞取栓术。结果30例患者的血栓全部取出,术后病理证实均为血栓栓子。术前患侧体感诱发电位(SEP)、运动诱发电位(MEP)波幅明显小于健侧;术后SEP和MEP波幅恢复超过50%者8例、超过30%者12例;术后3个月内肌力达到Ⅴ级4例,Ⅳ级8例,Ⅲ级8例,Ⅰ级和Ⅱ级10例。结论血管闭塞后机械取栓应用神经电生理监测,能最大程度地预知术前电生理情况、判断患者术后情况、及时进行肢体康复训练。Objective To explore the application of neuroelectrophysiological monitoring in mechanical thrombus removal after emergency vascular occlusion.Methods A retrospective analysis was carried out for 30 patients from the departments of neurosurgery in the Second Affiliated Hospital of Fujian Medical University from August 2019 to April 2020.The patients were aged 56-89 years old,with an average of(68.00±9.82)years old.There were 15 cases of internal carotid artery occlusion,8 cases of anterior cerebral artery occlusion,and 7 cases of middle cerebral artery occlusion.In all cases,the technique of embolization by mechanical stent was used in emergency after vascular occlusion.All the above cases were given arterial occlusion thrombectomy under neuroelectrophysiological monitoring.Results All thrombi of the 30 patients were all removed,and postoperative pathology confirmed that they were all thrombus emboli.The amplitude of the preoperative somatosensory evoked potential(SEP)and motor evoked potential(MEP)of the affected side was significantly smaller than that of the healthy side.After the operation,the amplitude of SEP and MEP recovered more than 50%in 8 cases and more than 30%in 12 cases.Within 3 months after operation,muscle strength reached gradeⅤin 4 cases,gradeⅣin 8 cases,gradeⅢin 8 cases,and gradeⅠandⅡin 10 cases.Conclusion The application of neuroelectrophysiological monitoring for mechanical thrombus removal after vascular occlusion can predict the preoperative electrophysiological condition to the greatest extent,better judge the patient′s postoperative condition,and perform limb rehabilitation training more timely.

关 键 词：机械取栓 神经电生理监测 血管闭塞 预后 

分 类 号：R741.044[医药卫生—神经病学与精神病学]