术中电生理监测下获得性免疫缺陷综合征相关脊髓病变患者的手术治疗  

Surgical treatment of acquired immunodeficiency syndrome-related spinal cord disease under intraoperative neurological monitoring

作　　者：王芳 冯恩山 丁兴欢 梁博 Wang Fang;Feng Enshan;Ding Xinghuan;Liang Bo(Department of Neurosurgery,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院神经外科,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2023年第2期133-137,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：首都医科大学附属北京地坛医院桥梁计划(No.DTQL202101)。

摘　　要：目的探讨获得性免疫缺陷综合征(AIDS)相关脊髓病变患者手术过程中应用术中电生理监测的必要性。方法收集首都医科大学附属北京地坛医院神经外科2013年9月至2021年9月收治的AIDS合并脊髓占位性病变患者22例,对具备手术指征AIDS相关脊髓病变患者行手术治疗并于术中给予电生理监测,术后评估手术效果,出院后随访神经功能,并进行回顾性分析。结果入组22例AIDS患者均行手术治疗并于术中行电生理监测,其中20例(90.9%)患者术中监测无异常表现,手术过程顺利,2例(9.1%)出现监测报警,予以暂停手术,波幅恢复后,继续手术,术后早期及随访期内未见严重神经功能并发症。术后1周,行McCormick脊髓功能评定分级:Ⅰ级患者12例(54.5%),Ⅱ级患者2例(9.1%),Ⅲ级患者7例(31.8%),Ⅳ级患者1例(4.5%)。术后随访:2例(9.1%)患者死亡,6例(27.3%)患者自诉疼痛缓解,5例(22.7%)患者肢体功能障碍改善,3例(13.6%)患者麻木感好转,1例(4.5%)患者灼热感消失,4例(18.2%)患者临床症状较术前无变化,1例(4.5%)患者大便功能障碍加重。结论应用术中电生理监测为AIDS相关脊髓病变患者实施手术,有助于及时反馈术中神经功能完整性变化,提示术者及早采取干预措施,有效降低术后神经功能缺损的风险,明显改善患者的愈后。Objective To investigate the necessity for applying intraoperative electrophysiological monitoring in the surgical treatment of patients with acquired immunodeficiency syndrome(AIDS)-related spinal cord lesions.Methods Total of 22 patients with AIDS combined with spinal cord space-occupying lesions admitted to the Department of Neurosurgery,Beijing Ditan Hospital,Capital Medical University from September 2013 to September 2021 were collected.Patients with spinal cord lesions associated with surgical indications were treated surgically and underwent intraoperative electrophysiological monitoring.Surgical results were evaluated after surgery,and neurological function was followed up after discharge and analyzed,retrospectively.Results All 22 patients with AIDS were treated by surgery and underwent electrophysiological monitoring,among whom,20 patients(90.9%)had no abnormal intraoperative monitoring,and the operation was successful;2 patients(9.1%)had a monitoring alarm,and the operation was suspended,after the amplitude recovered,the operation was continued,and no serious neurological complications were observed in the early postoperative period and during the follow-up period.One week after surgery,McCormick spinal cord function was graded:12 patients(54.5%)were gradeⅠ,2 patients(9.1%)were gradeⅡ,7 patients(31.8%)were gradeⅢand 1 patient(4.5%)was gradeⅣ.Postoperative follow-up:2 patients(9.1%)died,6 patients(27.3%)reported pain relief,5 patients(22.7%)with improved limb dysfunction,3 patients(13.6%)with improved numbness,1 patient(4.5%)with burning feeling disappeared,4 patients(18.2%)had no change in clinical symptoms,and 1 patient(4.5%)with increased stool dysfunction.Conclusions The application of intraoperative electrophysiological monitoring for patients with AIDS-related spinal cord lesions can facilitate timely feedback of intraoperative neurological integrity changes,it suggests that the surgeon took early intervention measures to effectively reduce the risk of postoperative neurological deficit an

关 键 词：获得性免疫缺陷综合征 脊髓病变 术中电生理监测 

分 类 号：R512.91[医药卫生—内科学] R687.3[医药卫生—临床医学]