多模式电生理监测在痉挛型脑瘫患者高选择性脊神经后根切断术中的应用  

Application of multi-mode electrophysiological monitoring in highly selective posterior rhizotomy for patients with spastic cerebral palsy

作　　者：张文瑞 何百祥[2] 廉海平[2] 高巍[1] ZHANG Wenrui;HE Baixiang;LIAN Haiping;GAO Wei(Department of Anesthesiology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Neurosurgery,The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China)

机构地区：[1]西安交通大学第一附属医院麻醉科,陕西西安710061 [2]西安交通大学第一附属医院神经外科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2021年第3期353-358,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省创新人才推进计划—青年科技新星项目(2019KJXX-046);国家自然科学基金面上项目(81771485,81971290);陕西省重点研发计划项目(2020SF-136);校级中央高校基本科研业务费(xjj2018262)。

摘　　要：目的探讨多模式电生理监测技术在痉挛型脑瘫患者高选择性脊神经后根切断术(SPR)中的应用。方法回顾性收集2019年1月至2019年12月在本院神经外科接受SPR的痉挛型脑瘫患者的资料,所有患者术中应用脑电双频指数(BIS)、体感诱发电位(SEP)和肌电图(EMG)联合监测麻醉深度、脊髓功能、多组肌群的刺激反应,记录并总结术中电生理监测异常、术后离院时手术疗效和并发症情况,以及术后6个月痉挛缓解情况和运动功能恢复情况。结果18例患者术中BIS参数为60~75,EMG波幅异常1例(5.6%),SEP波幅下降1例(5.6%)。术前双下肢肌张力平均为3.6级,术后为1.4级,下降了2.2级。长期随访有16例(88.9%),其中12例(75%)痉挛完全缓解,4例(25%)明显改善,步态功能改善率100%,无并发症发生。结论多模式电生理监测技术是SPR提高手术成功率的有效方法,可提高脊神经后根切除比例的准确率,降低脊髓受损风险,改善不良预后。Objective To explore the application of multi-mode electrophysiological monitoring technology in highly selective posterior rhizotomy(SPR)of patients with spastic cerebral palsy.Methods We retrospectively collected data on patients with systolic cerebral palsy who underwent SPR in our hospital from January 2019 to December 2019.Bispectral index(BIS),somatosensory evoked potentials(SEP)and electromyography during surgery of all the patients were measured.We used EMG to monitor the depth of the anus,spinal cord function,and the stimulation response of multiple muscle groups,and recorded and summarized abnormal intraoperative electrophysiological monitoring,surgical treatment and complications during displacement and discharge,and relief and exercise functional recovery six months after the surgery.Results The intraoperative BIS parameters of 18 patients were 60-75,the EMG amplitude was abnormal in 1 case(5.6%),and the SEP amplitude decreased in 1 case(5.6%).The preoperative muscle tension of both lower extremities was 3.6 on average,and the postoperative muscle tension was 1.4,with a decrease by 2.2 grades.There were 16 cases(88.9%)in long-term follow-up,among which 12 cases(75%)had complete relief of spasm,4 cases(25%)had significant improvement,gait function improvement rate was 100%,and no complications occurred.Conclusion Multi-mode electrophysiological monitoring technology is an effective method for SPR to increase the success rate of surgery.It can increase the accuracy of the ratio of posterior root resection of spinal nerves,reduce the risk of spinal cord damage,and improve the poor prognosis.

关 键 词：痉挛型脑瘫 高选择性脊神经后根切断术 肌电图 体感诱发电位 脑电双频指数 

分 类 号：R742.3[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]