术中球海绵体肌反射监测对脊髓圆锥或马尾肿瘤手术患者肠道功能结局的预测价值  

Predictive value of intraoperative bulbocavernosus reflex monitoring for bowel function outcomes of patients undergoing conus medullaris or cauda equina tumor surgery

作　　者：金妍文 樊星 吴晓[1] 陶晓蓉 贾文清[2] 乔慧[1] Jin Yanwen;Fan Xing;Wu Xiao;Tao Xiaorong;Jia Wenqing;Qiao Hui(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

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

出　　处：《中华神经外科杂志》2023年第4期368-373,共6页Chinese Journal of Neurosurgery

基　　金：首都卫生发展科研专项(2022-2-1073)。

摘　　要：目的探讨术中球海绵体肌反射(BCR)监测对脊髓圆锥或马尾肿瘤手术患者肠道功能结局的预测价值。方法回顾性分析2021年9月至2022年3月首都医科大学附属北京天坛医院神经外科学中心收治的88例术中行BCR监测的脊髓圆锥或马尾肿瘤手术患者的临床资料,记录术中双侧BCR波幅的下降率,选取BCR波幅下降率较明显一侧(以波幅变化率来表示)作为术中监测的评估指标。根据神经源性肠道功能障碍量表评分(NBDS),分为肠道功能良好组(NBDS≤6分)和肠道功能不良组(NBDS>6分)。采用单因素和多因素logistic回归分析探讨术后1、6个月肠道功能结局的影响因素。绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),以确定BCR的临界值及其预测价值。结果88例患者中,84例(95.5%)患者术中引出有效的BCR波形,BCR波幅变化率[M(Q1,Q3)]为16.7%(3.7%,51.7%)。84例中,58例(69.0%)肿瘤全切除,26例(31.0%)未全切除;术后1、6个月的肠道功能良好率分别为84.5%(71例)和86.9%(73例)。单因素分析结果显示,仅肿瘤切除程度、BCR波幅变化率对术后1、6个月肠道功能结局的影响有统计学意义(均P<0.05)。多因素logistic回归分析显示,BCR波幅变化率是术后1、6个月肠道功能结局的主要预测因素(OR=1.12,95%CI:1.04~1.21;OR=1.10,95%CI:1.03~1.19,均P<0.05)。BCR波幅变化率预测术后1、6个月肠道功能结局的临界值分别为72.7%、86.9%,灵敏度分别为94.5%、92.4%,特异度分别为95.1%、93.7%,AUC分别为0.97、0.95。结论术中BCR监测有助于预测脊髓圆锥或马尾肿瘤患者的术后肠道功能结局,BCR波幅下降>87%可作为预测短、中期随访肠道功能不良的术中预警标准。Objective To investigate the predictive value of intraoperative bulbocavernosus reflex(BCR)monitoring for bowel function outcomes of patients undergoing conus medullaris or cauda equina tumor surgery.Methods From September 2021 to March 2022,a total of 88 patients with conus medullaris or cauda equina tumors underwent surgery and intraoperative BCR monitoring in the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University and their clinical data were retrospectively analyzed.The reduction ratio of bilateral BCR amplitude during the operation was documented,and the side with higher reduction ratio of BCR amplitude(reflected by the ratio of change in amplitude)was selected as the evaluation index for intraoperative monitoring.According to the Neurogenic Bowel Dysfunction Score(NBDS),the patients were divided into good bowel function group(NBDS≤6 points)and poor bowel function group(NBDS>6 points).Univariate and multivariate logistic regression analyses were used to explore the influencing factors of bowel function outcome at 1 and 6 months after operation.Receiver operating characteristic(ROC)curve was plotted and area under the curve(AUC)was calculated to determine the critical value of BCR and its predictive value.Results Among the 88 patients,84(95.5%)patients demonstrated effective BCR waveform during operation,and the BCR amplitude change ratio[M(Q1,Q3)]was 16.7%(3.7%,51.7%).Among them,58 cases(69.0%)received total tumor resection,and 26 cases(31.0%)had incomplete tumor resection.The good bowel function rate was 84.5%(71/84)and 86.9%(73/84)at 1 month and 6 months after operation respectively.The results of univariate analysis showed that only the degree of tumor resection and the change rate of BCR amplitude had statistically significant effects on the outcome of bowel function at 1 month and 6 months after operation(both P<0.05).Multivariate logistic regression analysis showed that the change ratio of BCR amplitude was the main influencing factor of bowel function outcome at 1 month and 6

关 键 词：脊髓 神经源性肠道功能障碍 监测 手术中 球海绵体肌反射 脊髓圆锥肿瘤 马尾肿瘤 

分 类 号：R739.42[医药卫生—肿瘤]