神经电生理监测在开颅动脉瘤夹闭术中的应用  

Application of neuroelectrophysiological monitoring in craniotomy aneurysm clipping

作　　者：唐凤娇 丰育功[1] 吴蒙蒙[1] 栗世方[1] 刘伟[1] Tang Fengjiao;Feng Yugong;Wu Mengmeng;Li Shifang;Liu Wei(Department of Neurosurgery,The Affiliated Hospital of Qingdao University,Shandong Province,266005,China)

机构地区：[1]青岛大学附属医院神经外科,山东省青岛市266005

出　　处：《现代电生理学杂志》2021年第3期135-141,共7页Journal of Modern Electrophysiology

摘　　要：目的:探讨神经电生理监测在开颅动脉瘤夹闭术中的应用价值。方法:回顾性纳入2019年4月至2020年4月就诊于青岛大学附属医院神经外科动脉瘤患者142例,术前行颅脑CTA和/或DSA检查确诊。所有患者均行开颅手术夹闭动脉瘤,根据术中是否采用电生理监测分为监测组(n=70例)和对照组(n=72例)。监测组术中应用体感诱发电位、运动诱发电位和/或脑干听觉诱发电位监测。记录术中监测异常变化,比较两组患者术后第1天出现新的神经功能障碍及预后随访情况。结果:监测组17例(24.3%)术中出现监测指标的变化,其中5例(7.1%)术后第1天出现了新的神经功能障碍,术后随访6个月,2例(2.9%)患者遗留永久神经功能障碍。对照组14例(19.4%)术后第1天出现新的神经功能障碍,术后随访6个月,9例(12.5%)患者遗留永久神经功能障碍。两组术后第1天出现新的神经功能障碍的发生率、住院天数、再手术情况及术后6个月预后良好率和致残率比较差异均有统计学意义(P<0.05),两组均无死亡病例。结论:开颅动脉瘤夹闭术中应用神经电生理监测,可及时发现术中脑组织缺血,并采取相应的干预措施,增加了手术的安全性,降低了术后并发症的发生率,改善了患者的预后。Objective: To explore the value of neuroelectrophysiological monitoring in craniotomy aneurysm clipping. Methods: A total of 142 patients with aneurysms in the Affiliated Hospital of Qingdao University from April 2019 to April 2020 were included retrospectively. They were diagnosed by brain CTA and/or DSA before operation. All patients underwent craniotomy to clamp aneurysms. According to whether electrophysiological monitoring was used during operation, they were divided into monitoring group(n=70 cases) and control group(n=72 cases). Somatosensory evoked potentials, motor evoked potentials and/or brain stem auditory evoked potential were used in the monitoring group. The abnormal changes of intraoperative monitoring were recorded, and the new neurological dysfunction on the first day after operation and prognosis were compared between the two groups. Results: In the monitoring group, 17 cases(24.3%) showed changes in monitoring indexes during operation, and 5 cases(7.1%) showed new neurological dysfunction on the first day after operation. Followup for 6 months, 2 cases(2.9%) left permanent neurological dysfunction. In the control group, 14 cases(19.4%) showed new neurological dysfunction on the first day after operation. Follow-up for 6 months, 9 cases(12.5%) left permanent neurological dysfunction. There were significant differences between the two groups in the incidence of new neurological dysfunction on the first day after operation, hospitalization days, reoperation, good prognosis rate and disability rate at six months after operation(P<0.05), and there were no deaths in both groups. Conclusion: The application of neuroelectrophysiological monitoring in craniotomy aneurysm clipping can timely find intraoperative cerebral ischemia and take corresponding intervention measures, which increases the safety of operation, reduces the incidence of postoperative complications and improves the prognosis of patients.

关 键 词：颅内动脉瘤 动脉瘤夹闭术 神经电生理监测 

分 类 号：R651.11[医药卫生—外科学]