微血管减压术中AMR监测对原发性面肌痉挛预后的评估价值分析  

Evaluation value of abnormal muscle response monitoring in efficacy of microvascular decompression in primary hemifacial spasm

作　　者：唐凤娇 刘伟[1] 栗世方[1] 徐东梅 丰育功[1] Tang Fengjiao;Liu Wei;Li Shifang;Xu Dongmei;Feng Yugong(Department of Neurosurgery,Affiliated Hospital of Qingdao University,Qingdao 266005,China)

机构地区：[1]青岛大学附属医院神经外科,青岛266005

出　　处：《中华神经医学杂志》2022年第4期387-391,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨术中异常肌反应(AMR)监测对微血管减压术治疗原发性面肌痉挛疗效的评估价值。方法选择青岛大学附属医院神经外科自2019年4月至2020年12月收治的64例原发性面肌痉挛患者进行研究,患者术中均行AMR监测并依据监测结果分为AMR完全消失组、AMR显著变化组及AMR无明显变化组。随访观察3组患者术后1周及1年时痉挛症状的缓解情况,并回顾性分析AMR监测评估术后疗效的特异性、敏感性以及AMR变化与术后疗效间的关系。结果术中AMR监测评估微血管减压术后1周疗效的特异性和敏感性分别为89.7%和66.7%,术后1年的特异性和敏感性分别为86.7%和50.0%。46例AMR完全消失组、8例显著变化组及10例无明显变化组患者间术后1周临床缓解率的差异有统计学意义(P<0.05),术后1年临床缓解率的差异无统计学意义(P>0.05)。46例AMR完全消失组患者中,垫入Teflon棉片前AMR完全消失患者与垫入Teflon棉片后AMR完全消失患者间术后1周及1年临床缓解率的差异均无统计学意义(P>0.05)。结论术中AMR监测在评估微血管减压术后患者的痉挛症状缓解方面具有高度特异性和中度敏感性;术中AMR完全消失与术后短期疗效有关,却不是长期疗效的可靠指标;术中AMR完全消失时间对评估患者疗效无指导意义。Objective To explore the evaluation value of abnormal muscle response(AMR)monitoring in efficacy of microvascular decompression in primary hemifacial spasm.Methods A retrospective study was performed.Sixty-four patients with primary hemifacial spasm,admitted to our hospital from April 2019 to December 2020,were chosen.All patients underwent intraoperative AMR monitoring and were divided into AMR complete-disappeared group,AMR significant-changed group and AMR not significant-changed group according to the monitoring results.The relief of spasticity symptoms among the three groups was observed one week and one year after surgery.The specificity and sensitivity of AMR monitoring in evaluating the efficacy,the relations between intraoperative AMR changes and postoperative efficacy after microvascular decompression were analyzed.Results The specificity and sensitivity of AMR monitoring in predicting spasmodic relief after microvascular decompression were 89.7%and 66.7%,respectively,at one week,and 86.7%and 50.0%,respectively,at one year.There were statistical differences in clinical remission rate one week after microvascular decompression among AMR complete-disappeared group(n=46),AMR significant-changed group(n=8)and AMR not significant-changed group(n=10,P<0.05);there were no significant differences in clinical remission rate one year after microvascular decompression among the three groups(P>0.05).There was no significant difference in clinical remission rate one week and one year after microvascular decompression between patients having AMR complete disappearance before Teflon and patients having AMR complete disappearance after Teflon(P>0.05).Conclusion AMR monitoring has high specificity but modest sensitivity in predicting spasmodic relief after microvascular decompression;intraoperative AMR disappearance is associated with short-term efficacy,but it is not a reliable indicator for long-term efficacy;the time of disappearance of intraoperative AMR has no guiding significance in judging the efficacy of patient

关 键 词：面肌痉挛 异常肌反应 微血管减压术 术中神经电生理监测 

分 类 号：R651.3[医药卫生—外科学]