术中D波监测及电位翻转技术对髓内肿瘤患者神经功能的保护价值  

The protective role of D wave monitoring and potential reversal technique for nerve function in spinal cord intramedullary tumor surgery

作　　者：刘伟豪 王博[1] 吴晓 张耀武[1] 樊星 乔慧 贾文清[1] Liu Weihao;Wang Bo;Wu Xiao;Zhang Yaowu;Fan Xing;Qiao Hui;Jia Wenqing(Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科学中心,北京100070 [2]首都医科大学,北京市神经外科研究所,北京100070

出　　处：《中华神经外科杂志》2023年第1期8-13,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81891004);北京市医院管理中心临床医学发展专项经费(XMLX202109)。

摘　　要：目的探讨术中运动诱发电位(MEP)及体感诱发电位(SEP)联合D波监测和电位翻转技术对行髓内肿瘤切除术患者神经功能的保护作用。方法采用历史对照研究方法,分析2019年7月至2020年12月于首都医科大学附属北京天坛医院神经外科学中心行髓内肿瘤切除术的76例患者(术前McCormick评级为Ⅰ~Ⅱ级)的临床资料。其中,38例患者术中进行MEP和SEP监测(常规监测组),38例采用MEP、SEP联合D波及电位翻转技术监测(联合监测组)。比较两组患者术前和术后、随访期的McCormick评级、术后重症监护时间、住院时长、肿瘤切除程度、健康调查简表(SF-36)评分等指标,从而评价不同监测模式对患者神经功能的保护价值。结果两组患者的性别构成、年龄、肿瘤累及脊髓节段、首发症状、术前McCormick评级的差异均无统计学意义(均P>0.05)。术后6个月联合监测组的McCormick评级优于常规监测组(χ^(2)=5.68,P=0.017),而两组术后2周McCormick评级的差异无统计学意义(χ^(2)=0.26,P=0.642)。两组患者的术后重症监护时间、住院时长、肿瘤全切除与次全切除比例的差异均无统计学意义(均P>0.05)。术后6个月两组患者SF-36评分的差异有统计学意义(t=3.10,P=0.003)。对于预测神经功能所采用的电生理指标,常规监测组的阴性、阳性预测率分别为86.7%和25.0%;联合监测组分别为93.9%和40.0%。结论髓内肿瘤切除术中应用常规神经电生理监测联合D波和电位翻转技术,有助于更好地保护患者的神经功能,且在评估预后方面可发挥重要作用。Objective To investigate the protective role of conventional motor evoked potentials(MEP)and somatosensory evoked potentials(SEP)in combination with D wave monitoring and potential reversal techniques for patients′neurological function during spinal cord intramedullary tumor resection.Methods We conducted a historical control study on clinical data of 76 patients who underwent spinal cord intramedullary tumor resection at the Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University from July 2019 to December 2020(preoperative McCormick gradeⅠtoⅡ).All patients were divided into conventional monitoring group(using conventional electrophysiological techniques for interoperative monitoring,including MEP and SEP,38 cases)and combined monitoring group(using the conventional electrophysiological techniques combined with D wave monitoring and potential reversal technique,38 cases).Patients′preoperative McCormick rating and its changes at 2 weeks post operation,as well as during postoperative follow-up period,postoperative intensive care duration,length of hospital stay,tumor resection rate,Short Form 36(SF-36)score,and other indicators were compared between the two groups to examine the protective effects of different monitoring methods on patients′neurological function.Results There were no statistically significant differences between the two groups of patients in terms of gender,age,location of tumor,and initial symptoms and preoperative McCormick rating(all P>0.05),while the McCormick grade of the combined monitoring group was superior to that of the conventional monitoring group 6 months after operation(χ^(2)=5.68,P=0.017).The McCormick grade 2 weeks after the operation did not differ between the two groups(χ^(2)=0.26,P=0.642).No significant differences were found in postoperative intensive care duration,hospital stay,or total/subtotal tumor resection rate(all P>0.05).SF-36 scores significantly differed between the two groups at 6 month post operation(t=3.10,P=0.003).For the electrophysiol

关 键 词：脊髓肿瘤 神经外科手术 神经电生理监测 D波 预后 

分 类 号：R739.42[医药卫生—肿瘤]