临床视觉电生理记录结果中常见伪迹的甄别及处理  

Distinction and processing of common artifact in clinical visual electrophysiology

作　　者：林俊 李世迎 Lin Jun;Li Shiying(Department of Ophthalmology,Southwest Hospital/Southwest Eye Hospital,Third Military Medical University(Army Medical University),Chongqing 400038,China;Department of Ophthalmology,Xiang'an Hospital of Xiamen University,Eye Institute of Xiamen University,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science,Fujian Engineering and Research Center of Eye Regenerative Medicine,School of Medicine,Xiamen University,Xiamen 361102,China)

机构地区：[1]陆军军医大学第一附属医院眼科、陆军军医大学西南医院眼科,重庆400038 [2]厦门大学附属翔安医院眼科、厦门大学眼科研究所、福建省眼科与视觉科学重点实验室、福建省眼再生医学工程研究中心、厦门大学医学院,厦门361102

出　　处：《中华实验眼科杂志》2023年第2期146-151,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金面上项目(81974138);国家重点基础研究发展计划项目(2018YFA0107301)。

摘　　要：目的探讨临床视觉电生理检查过程中产生伪迹的常见原因及解决方法。方法采用横断面研究方法,收集2012-2020年陆军军医大学第一附属医院的临床视觉电生理检查25001例,对照国际视觉电生理协会指导标准所提供的标准波形,确定典型的伪迹波形,分析其特征和原因,并针对伪迹原因提出减少及消除伪迹的方法。结果25001例中典型的伪迹波形有60例,常见原因可分为3大类:受检者因素、环境因素和机器设备因素,具体原因包括患者头面部肌肉紧张42例、瞬目9例、50 Hz工频伪迹4例、放大器异常2例、其他3例,分别占70.0%、15.0%、6.7%、3.3%、5.0%。处理策略:(1)检查过程中关注患者头面部肌肉紧张、瞬目、注意力不集中等患者自身影响因素,可提前告知患者检查流程,与患者交流放松身心;(2)建议使用高质量的50 Hz硬件陷波器,保证地线连接良好,移除视觉电生理仪器附近的大功率电器以降低50 Hz伪迹;(3)充分清洁皮肤,使参考电极阻抗降至1 kΩ以下减少阻抗伪迹。结论临床视觉电生理检查中伪迹的类型和原因呈多样性,检查者需要准确判断伪迹因素并及时有效排除伪迹,提供更加精准的检测结果;同时加强临床医师对伪迹的了解,以便准确判读视觉电生理检查报告。Objective To explore the common causes and solutions for artifacts in clinical visual electrophysiological examination.Methods A cross-sectional study was performed.The clinical visual electrophysiological examination results of 25001 cases were collected from 2012 to 2020 at the Southwest Hospital/Southwest Eye Hospital,Third Military Medical University(Army Medical University).Artifacts were identified and analyzed according to the standard waveform provided by the International Society for Clinical Electrophysiology of Vision.The characteristics and causes of the artifact were analyzed.The solutions to reduce and eliminate the artifact were proposed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Southwest Hospital/Southwest Eye Hospital,Third Military Medical University(Army Medical University)(No.KY2020053).Results There were 60 typical artifacts identified among the 25001 cases.Common causes of the artifacts were classified as three categories,the factors related to subjects,environment,or instruments.Among the 60 cases,42(70.0%)were caused by tension in head and facial muscles of patients,9(15.0%)due to blinking of patients,4(6.7%)resulted from 50 Hz power frequency artifact,2(3.3%)arisen from abnormal amplifier,and 3(5.0%)for other reasons.The strategies to avoid artifact were as follows.First,examiners could inform patients of the examination process in advance to help patients to relax and avoid the influencing factors,such as muscle tension in head and face,blinking,inattention and so on;second,high-quality 50 Hz hardware wave trap was recommended to reduce 50 Hz artifact,with good ground connection and removing of the high-power electrical appliances near the visual electrophysiological instrument;third,clean the skin sufficiently to reduce the reference electrode impedance to less than 1 kΩ.Conclusions There is a variety of artifact waveforms and causes.The technicians should make correct judgments and handle the artifact in time to pr

关 键 词：视觉诱发电位 视网膜电图 眼电图 伪迹 视觉电生理 

分 类 号：R770.4[医药卫生—眼科]