经皮针状电极在甲状腺术中喉返神经监测的研究  

Study on neurological monitoring with cortical electrodes in thyroidectomy

作　　者：王哓艳 钟琦[1] 马泓智[1] 郭伟[1] 丁硕 赵延明[1] 何雨蓉 李齐佳 WANG Xiaoyan;ZHONG Qi;MA Hongzhi;GUO Wei;DING Shuo;ZHAO Yanming;HE Yurong;LI Qijia(Department of Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院,耳鼻咽喉头颈外科学教育部重点实验室,北京100730

出　　处：《西安交通大学学报（医学版）》2024年第1期94-99,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：首都卫生发展科研专项(首发2022-2-2059)。

摘　　要：目的比较经皮针状电极和经口插管表面电极用于甲状腺术中神经监测的异同,并探讨在不适合经口插管或表面电极故障时,如何识别和保护喉返神经和迷走神经。方法收集并分析32例因甲状腺疾病接受手术治疗患者的临床资料,共计监测喉返神经和迷走神经各40侧,分别使用经口插管表面电极及经皮针状电极对神经进行监测,记录所获取的振幅及潜伏期。采用SPSS 26.0软件进行统计分析,采用配对t检验对潜伏期进行分析比较,采用秩和检验分析经皮针状电极与经口插管表面电极刺激所得振幅是否有差异。结果经皮针状电极用于甲状腺术中神经监测时,所有神经均被识别并获得与经口插管表面电极潜伏期和振幅相似的双相肌电信号,并可通过潜伏期有效鉴别喉返神经和迷走神经[(3.22±0.50)ms vs.(3.85±1.00)ms,P<0.05],与经口插管表面电极的监测效果[(3.04±0.58)ms vs.(3.89±1.07)ms,P<0.05]无明显差异;同时,经皮针状电极可视化操作度及安全性都更高,具有很大优势。结论经皮针状电极可有效辅助识别并保护喉返神经和迷走神经,是经口插管表面电极的重要补充。Objective To compare the synergies between the transcutaneous needle electrodes and the ETT surface electrodes used for neurological surveillance in thyroidology,and explore how to identify and protect recurrent laryngeal nerve and vagus nerve when the patient is not suitable for oral plug or surface electrodes are failure.Methods To collect and analyze the clinical data of 32 patients undergoing surgical treatment for thyroid disease,a total of 40 neurons of the recurrent laryngeal nerves and vagus nerves were monitored,and the amplitude and latency were recorded using ETT surface electrodes and transcutaneous needle electrodes for nerve monitoring,respectively.SPSS 26.0 software was used for statistical analysis,paired t-tests were used to analyze and compare the latency periods,and the rank sum test was used to analyze whether there is a difference in the amplitude obtained from stimulation of transcutaneous needle electrodes and ETT surface electrodes.Results When the transcutaneous needle electrodes were used in thyroid surgery,we identified all the nerves,obtained two-phase electrical signals similar to the latency and amplitude of the ETT surface electrodes,and could effectively identify the recurrent laryngeal nerve and vagus nerve[(3.22±0.50)ms vs.(3.85±1.00)ms,P<0.05]through the incapacity period,with no obvious difference in the monitoring effect from the ETT surface electrodes[(3.04±0.58)ms vs.(3.89±1.07)ms,P<0.05].At the same time,the visualization and safety of transcutaneous needle electrodes were higher,with great advantages.Conclusion Transcutaneous needle electrodes can effectively assist in identifying and protecting the recurrent laryngeal nerve and vagus nerve,and thus are an important supplement to ETT surface electrodes.

关 键 词：针状电极 神经监测 甲状腺手术 喉返神经 迷走神经 

分 类 号：R762[医药卫生—耳鼻咽喉科]