D波监测在脊髓髓内肿瘤手术中的应用价值  

Application value of D wave monitoring in intramedullary spinal cord tumor surgery

作　　者：李轲 樊星 陶晓蓉 吴晓[1] 刘佳佳 金妍文 杨骏[1] 贾文清[2] 乔慧[1] Li Ke;Fan Xing;Tao Xiaorong;Wu Xiao;Liu Jiajia;Jin Yanwen;Yang Jun;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9期881-886,共6页Chinese Journal of Neurosurgery

基　　金：首都卫生发展科研专项 (2022-2-1073)。

摘　　要：目的探讨脊髓髓内肿瘤术中脊髓直接波(D波)监测对患者术后运动功能结局的预测价值。方法回顾性分析2021年5月至2022年8月首都医科大学附属北京天坛医院神经外科学中心手术治疗的74例脊髓髓内肿瘤患者的临床资料。患者术中均行D波监测,记录术中D波波幅的下降率。分别于术前,术后1、6个月采用改良McCormick评级(MMS)标准评估患者的脊髓神经功能状况,并根据术前、术后评级情况将患者分为新发功能障碍组(MMS升高≥1级)和无新发功能障碍组。采用单因素和多因素logistic回归分析筛选对术后运动功能结局有影响的因素。绘制受试者工作特征(ROC)曲线,并计算曲线下面积(AUC),以确定D波的临界值及其对患者术后运动功能结局的预测价值。结果74例患者中,肿瘤全切除63例,近全切除11例。共有46例(62.2%)患者术中D波波幅下降,其中7例(15.2%)D波波幅下降率>50%。术后1个月新发功能障碍组有54例,无新发功能障碍组20例,两组术中D波波幅下降率的中位数(Q1,Q3)分别为20.2%(0,42.1%)、4.7%(0,24.2%),差异无统计学意义(P=0.133);术后6个月新发功能障碍组有11例,无新发功能障碍组63例,术中D波波幅下降率的中位数(Q1,Q3)分别为52.2%(42.5%,64.4%)、6.5%(0,30.3%),差异有统计学意义(P<0.001);多因素logistic回归分析显示,术中D波波幅下降率是患者术后6个月运动功能结局的独立影响因素(OR=1.25,95%CI:1.06~1.47,P=0.008)。ROC曲线分析显示,D波波幅下降率预测6个月运动功能结局的临界值为39.8%,灵敏度和特异度分别为90.9%、90.5%。结论术中D波监测结果可有效预测脊髓髓内肿瘤患者术后6个月运动功能的结局;D波波幅下降率≥40%可作为术中的预警标准。Objective To investigate the predictive value of intraoperative direct wave(D wave)monitoring for the outcome of postoperative motor function in patients with intramedullary spinal cord tumors.Methods A retrospective analysis was conducted on the clinical data of 74 patients with intramedullary spinal cord tumors who were treated at the Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University from May 2021 to August 2022.All patients received intraoperative monitoring of D wave,and the reduction rate of D wave amplitude during operation was documented.The modified McCormick Scale(MMS)was used to evaluate the clinical status of the patients before operation,1 month and 6 months after operation,and they were divided into new-onset functional impairment group and non-new-onset functional impairment group according to the preoperative and postoperative rating.Univariate and multivariate logistic regression analyses were used to determine the influencing factors of postoperative motor function outcome.Receiver operating characteristic(ROC)curves were drawn and the area under the curve(AUC)was calculated to determine the critical value of D wave and its value in predicting the outcome of postoperative motor function.Results Among the 74 patients,total resection was performed in 63 cases and subtotal resection in 11 cases.Intraoperative monitoring revealed a decrease in D-wave amplitude in 46 cases(62.2%)of the patients,with 7 cases(15.2%)exhibiting a decrease of more than 50%in D-wave amplitude.At 1 month postoperatively,there were 54 cases of new-onset functional impairments and 20 cases without new-onset functional impairments.The median intraoperative decrease in D-wave amplitude was 20.2%(Q1,Q3:0,42.1%)in the new-onset functional impairment group and 4.7%(Q1,Q3:0,24.2%)in the non-new-onset functional impairment group,with no statistically significant difference(P=0.133).At 6 months postoperatively,there were 11 cases of new-onset functional impairments and 63 cases without new-onset functional impair

关 键 词：脊髓肿瘤 神经电生理监测 监测 手术中 直接波 运动功能 预测 

分 类 号：R739.42[医药卫生—肿瘤]