复合肌肉动作电位监测在全身麻醉脑深部电刺激术中的应用分析  

Application analysis of intraoperative compound muscle action potential monitoring in deep brain stimulation under general anesthesia

作　　者：吴倩倩[1] 陈思[1] 徐淑军[1] 李卫国[1] 马翔宇[1] 徐硕[1] 杨宁[1] 郭兴[1] 张超[1] 李超[1] Wu Qianqian;Chen Si;Xu Shujun;Li Weiguo;Ma Xiangyu;Xu Shuo;Yang Ning;Guo Xing;Zhang Chao;Li Chao(Department of Neurosurgery,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院神经外科,济南250012

出　　处：《中华神经外科杂志》2022年第7期723-729,共7页Chinese Journal of Neurosurgery

摘　　要：目的探讨术中记录复合肌肉动作电位(CMAP)在全身麻醉脑深部电刺激术(DBS)中的可行性,以及其在电极定位中的作用。方法回顾性分析2016年1月至2019年12月于山东大学齐鲁医院神经外科接受全身麻醉下双侧丘脑底核(STN)DBS的30例帕金森病患者(简称全麻组),以及同期接受局部麻醉与全身麻醉相联合的双侧STN-DBS的30例帕金森病患者(简称局麻+全麻组)的临床资料。全麻组患者术中选择双侧口轮匝肌、大小鱼际肌和踇短屈肌,记录CMAP的引出情况。局麻+全麻组患者在清醒状态下给予术中电刺激,并记录出现锥体束反应的情况。比较两组患者的刺激电压阈值、术后CT与术前MRI影像融合结果显示的电极位置,以及与术前(药物关期)相比,两组术后开机3个月(药物关期)统一帕金森病评定量表第三部分(UPDRS-Ⅲ)评分的改善率。结果全麻组与局麻+全麻组患者的年龄、病程及术前药物关期UPDRS-Ⅲ评分的差异均无统计学意义(均P>0.05),而两组性别比例的差异存在统计学意义(P<0.05)。(1)30例全麻组患者给予术中电刺激时均记录到典型的CMAP。(2)全麻组3组肌肉CMAP引出率的差异有统计学意义(P<0.05),口轮匝肌最高(60/60),其次是大小鱼际肌(35/60),踇短屈肌未记录到CMAP。(3)全麻组中3例患者、局麻+全麻组中4例患者进行了电极位置的调整;两组中未做电极位置调整的患者相比较,电压阈值的差异无统计学意义(P>0.05)。(4)两组患者术后CT与术前MRI的融合结果显示电极位置良好,全麻组双侧副反应触点外缘距内囊内缘的距离与局麻+全麻组的差异均无统计学意义(均P>0.05)。(5)两组患者在术后3个月UPDRS-Ⅲ评分改善率方面的差异无统计学意义(P>0.05)。结论全麻DBS中电刺激时记录CMAP是一项安全、可行且有效的技术;其中面部及上肢的CMAP更容易被记录到;电压阈值的大小能够为电极与内囊相对距离的判断�Objective To explore the feasibility of intraoperative recording of compound muscle action potential(CMAP)in deep brain stimulation(DBS)under general anesthesia and its role in the lead positioning.Methods A retrospective analysis was performed on the clinical data of 30 patients with Parkinson′s disease(PD)who received DBS of bilateral subthalamic nucleus(STN)under general anesthesia at the Department of Neurosurgery,Qilu Hospital of Shandong University from January 2016 to December 2019(referred to as the general anesthesia group)and 30 PD patients undergoing bilateral STN-DBS under local anesthesia combined with general anesthesia(referred to as local+general anesthesia group)during the same period of time.In the general anesthesia group,bilateral orbicularis oris muscles,thenar muscle,and flexor hallucis brevis muscle were selected to record the CMAP waves during the operation.The patients in the local+general anesthesia group received intraoperative electrical stimulation in an awake state,and the presence of pyramidal tract reactions was recorded.The threshold voltage,the electrode position verified by the fusion of postoperative CT and preoperative MRI images,and the improvement rates of Unified Parkinson′s Disease Rating Scale partⅢ(UPDRS-Ⅲ)score in the two groups in the medication-off period at 3 months after operation were compared.Results There was no significant difference between general anesthesia group and local+general anesthesia group in the patent′s age,course of disease and UPDRS-Ⅲscore in preoperative medication-off period(all P>0.05).Difference in sex between the two groups were significant(P<0.05).(1)Typical CMAPs were recorded in 30 patients in the general anesthesia group when they were given intraoperative electrical stimulation.(2)There were differences in the induction rate of CMAP among the three groups(P<0.05),which was the highest for the orbicularis oris muscle(60/60),followed by the thenar muscle(35/60),and no CMAP was recorded in the flexor hallucis brevis muscle.(3)Th

关 键 词：深部脑刺激法 帕金森病 麻醉 全身 术中电刺激 复合肌肉动作电位 电极定位 

分 类 号：R614.2[医药卫生—麻醉学]