听神经瘤切除术中SEP联合ABR监测对面、听神经的保护作用  

A Study of the Protective Effect of SEP Combined with ABR Monitoring on Facial and Auditory Nerve During Excision of Acoustic Neuroma

作　　者：戚钰 郑伟[1] 胡正权[1] 李娜[1] 刘杰 Qi Yu;Zheng Wei;Hu Zhengquan;Li Na;Liu Jie(Xuzhou Central Hospital,Xuzhou,221000,China)

机构地区：[1]江苏省徐州市中心医院麻醉科,徐州221000

出　　处：《听力学及言语疾病杂志》2022年第2期168-172,共5页Journal of Audiology and Speech Pathology

摘　　要：目的探讨听神经瘤切除术中采用体感诱发电位(somatosensory evoked potential,SEP)联合听性脑干反应(auditory brainstem response,ABR)监测对面、听神经的保护作用。方法以128例听神经瘤切除术患者为研究对象,随机分为对照组(64例)和研究组(64例),对照组术中行肌电图(EMG)联合ABR监测,研究组术中采用SEP、EMG、ABR联合监测;比较两组面、听神经保护情况。结果研究组与对照组手术结束时ABR引出率(分别为78.13%、75.00%)差异无统计学意义(χ^(2)=0.174,P=0.676),其中研究组波形分化良好率(78.00%)高于对照组(58.33%,χ^(2)=4.380,P=0.036);两组术中ABR波Ⅰ、Ⅲ、Ⅳ潜伏期及各波间期均较手术开始时延长,波Ⅴ幅值降低(均为P<0.05),手术结束后向手术开始水平恢复;研究组肿瘤全切率、面神经解剖保留率、耳蜗神经解剖保留率均高于对照组(分别为χ^(2)=4.571,P=0.033;χ^(2)=4.873,P=0.027;χ^(2)=4.758,P=0.029);术后研究组面神经功能良好率(87.50%,56/64)高于对照组(70.31%,45/64)(χ^(2)=5.680,P=0.017);研究组New Hannover听力分级为1~2级者占术前该级患者的比例(86.0%,43/50)高于对照组(65.31%,32/49)(χ^(2)=5.770,P=0.016)。结论听神经瘤切除术中采用SEP联合ABR监测对面、听神经可起到有效的监护作用,能够减少面、听神经功能损伤,且安全可靠。Objective To explore the protective effect of somatosensory evoked potential(SEP)combined with auditory brainstem response(ABR)monitoring on facial and auditory nerve during excision of acoustic neuroma resection.Methods A total of 128 patients underwent acoustic neuroma resection were randomly divided into control group and experiment group,the control group underwent electromyography(EMG)combined with ABR monitoring during the operation,and the study group used SEP,EMG,ABR combined monitoring during the operation.The changes of ABR during operation,the postoperative tumor resection and facial and auditory nerve retention in the two groups,facial nerve function,auditory nerve function,and incidence of complications in the two groups within 6 months after operation were compared.Results There was no significant difference in the percentage of BAEP elicitation rate between the two groups at the end of operation(χ^(2)=0.174,P=0.676),and the good rate of waveform differentiation in the study group was higher than that in the control group(χ^(2)=4.380,P=0.036).Compared with beginning of the operation,the incubation period and peak-to-peak period of each wave during the operation were significantly prolonged,and the amplitude was significantly reduced(P<0.05),after operation,the incubation period,peak-to-peak period and amplitude of each wave gradually recovered towards beginning of the operation.The total tumor resection rate,facial nerve anatomical retention rate and cochlear nerve anatomy retention rate of the study group were higher than those of the control group(χ^(2)=4.571,P=0.033;χ^(2)=4.873,P=0.027;χ^(2)=4.758,P=0.029).There were significant difference in the distribution of facial nerve function grades between the two groups of patients 6 months after operation(P<0.05),and the good rate of facial nerve function in the study group was higher than that in the control group(χ^(2)=5.680,P=0.017).The proportion of New Hannover listening grading level 1~2 take up level 1~2 before surgery patients in the stud

关 键 词：体感诱发电位 听性脑干反应 听神经瘤 面神经 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]