神经电生理监测对急诊机械取栓术后患者神经功能预后的预测价值  

Predictive value of neuroelectrophysiological monitoring for prognosis of neurological function after emergency mechanical thrombectomy

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 362000,Fujian,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362000

出　　处：《中国中西医结合急救杂志》2022年第2期154-158,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：福建省自然科学基金(2018J01281);福建省泉州市高层次人才创新创业项目(2019C026R)。

摘　　要：目的探讨术中神经电生理监测指标对急性颅内大血管闭塞机械取栓术后患者神经功能的预测价值。方法采用回顾性研究方法。收集2019年5月至2020年5月福建医科大学附属第二医院神经外科收治的68例急性颅内大血管闭塞机械取栓术后患者的临床资料,包括患者性别、年龄、体重、吸烟史、饮酒史、心房颤动(房颤)、高血压、糖尿病、心力衰竭、高脂血症、脑血管病史、术前美国国立卫生研究院卒中量表(NIHSS)评分、躯体感觉诱发电位(SEP)分级、取栓前后拇展肌运动诱发电位(MEP)的波幅比值,以及术后1周、3个月及6个月改良Rankin量表(mRS)评分。按神经功能结局将患者分为预后良好组(术后1周25例,术后3个月33例,术后6个月36例)和预后不良组(术后1周43例,术后3个月35例、术后6个月32例)。比较不同神经功能预后两组患者一般资料的差异;采用单因素分析和多因素Logistic回归分析影响急性颅内大血管闭塞机械取栓术后患者神经功能预后的独立危险因素;并绘制受试者工作特征曲线(ROC曲线),评价各危险因素预测患者术后神经功能的预测价值。结果68例急性颅内大血管闭塞患者均在神经电生理监测下行机械取栓术,术后提示大血管再通。单因素分析显示:与预后良组比较,术后1周起,预后不良好组>65岁者比例、存在卒中或短暂性脑缺血发作(TIA)病史和脑血管疾病史比例均明显增多〔术后>65岁者比例:60.4%(26/43)比16.0%(4/25),存在卒中或TIA病史:69.8%(30/43)比16.0%(4/25),脑血管疾病:62.8%(27/43)比40.0%(10/25),均P<0.05〕,术前NIHSS评分≥15分的比例和术中SEP分级Ⅲ级比例均明显较高〔74.4%(32/43)比8.0%(2/25)和83.7%(36/43)比40.0%(10/25)〕,以及MEP波幅比值明显降低(0.57±0.36比1.32±0.43),差异均有统计学意义(均P<0.05),持续到术后6个月。多因素Logistic回归分析显示:术后1周,术前NIHSS评分是影响患者神经功�Objective To explore the predictive value of intraoperative neurophysiological monitoring indicators on neurological function in patients with acute intracranial large vessel occlusion after mechanical thrombectomy.Methods A retrospective research was conducted.The clinical data of 68 patients with acute intracranial large vessel occlusion after mechanical thrombectomy who were admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Fujian Medical University from May 2019 to May 2020 were collected,including patients'gender,age,weight,smoking history,alcohol consumption history,atrial fibrillation(AF),hypertension,diabetes,heart failure,hyperlipidemia,history of cerebrovascular disease,preoperative National Institutes of Health Stroke Scale(NIHSS)score,somatosensory evoked potential(SEP)classification,amplitude ratio of abductor pollicis muscle motor evoked potential(MEP)before and after thrombus removal and modified Rankin scale(mRS)score at 1 week,3 months and 6 months after surgery.According to neurological outcome,the patients were divided into good prognosis group(25 cases at 1 week after operation,33 cases at 3 months after operation,36 cases at 6 months after operation)and poor prognosis group(43 cases at 1 week after operation,35 cases at 3 months after operation and 32 cases at 6 months after operation).The differences in general data of patients with different prognosis were compared;univariate and multivariate Logistic regression analyses were used to analyze the independent risk factors affecting the neurological function prognosis of patients with acute intracranial large vessel occlusion after mechanical thrombectomy;and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of various risk factors in predicting postoperative neurological function in the patients.Results All 68 patients with acute intracranial large vessel occlusion underwent mechanical thrombectomy under neurophysiological monitoring,and the postoperative recanalizati

关 键 词：神经电生理 机械取栓 急性缺血性脑卒中 预后 

分 类 号：R74[医药卫生—神经病学与精神病学]