电生理监测在颅内动脉瘤栓塞术中的作用

发布时间：2018-05-11 20:45

本文选题：颅内动脉瘤 + 栓塞　；参考：《石河子大学》2015年硕士论文

【摘要】：目的:探讨多模式神经电生理监测在颅内动脉瘤栓塞术中预防脑缺血的价值。方法:回顾性分析2013年5月至2014年6月期间44例颅内动脉瘤血管内介入栓塞术患者,根据是否应用术中电生理监测分为两组,第一组为2013年5月至2013年11月术中未应用电生理监测21例(简称未监测组),第二组为2013年12月至2014年6月术中应用电生理监测23例(简称监测组),采用美国Cadwell Cascade 32导术中诱发电位监护系统,按照国际脑电10/20标准,放置电极及设定参数,按动脉瘤部位及相关血供区域监测体感诱发电位(somatosensory evoked potential SEP)、运动诱发电位(motion evoked potential MEP)、头皮脑电(scalp electroencephalogram EEG)及脑干听觉诱发电位(brainstem auditory evoked potential BAEP),各种监测波形均以开始置入导引导管后设置基线,观察术中各电生理指标变化情况。术后常规复查CT,患者术后第1天只要有意识水平及语言功能下降或任何肢体肌力、感觉比术前下降,即被认为有新的神经功能障碍存在,出院后3个月根据格拉斯哥预后量表(Glasgow Outcome Scale G0S)评分评价预后情况(5分视为恢复良好),对比分析两组术后第1天新发神经功能障碍及3个月后随访的预后情况(良好、致残、死亡)。结果:(1)两组患者一般资料比较,年龄、性别、术前Hunt-Hess分级、动脉瘤大小、动脉瘤部位及动脉瘤个数比较差异均无统计学意义(P0.05),具有可比性。(2)电生理监测组患者术后第1天出现新的神经功能缺损发生率为17.4%(4/23),未监测组为47.6%(10/21),两组比较差异有统计学意义(χ2=4.623,P0.05);术后3个月随访预后良好率(87.0%比57.1%)组间差异有统计学意义(χ2=4.919,P0.05),两组均无死亡病例。(3)监测组23例患者中,单一行SEP监测6例,SEP联合MEP监测5例,SEP联合头皮EEG8例,SEP联合BAEP监测1例,联合应用SEP、MEP及头皮EEG三种模式监测3例。13例患者术中电生理指标无异常改变,术后无新发神经功能障碍,10例术中电生理指标发生异常改变,术后出现新的神经功能障碍4例。电生理监测组术中SEP变化9例,MEP变化3例,头皮EEG变化4例,对其中9例电生理显示脑缺血患者,及时采取相应措施,如:罂粟碱解痉,暂停血管内操作,调整支架位置,弹簧圈解脱前撤出最后一个弹簧圈,手术结束前有3例患者电生理波形完全恢复,6例患者波形未完全恢复。1例患者术中SEP监测正常,但是右侧上肢的MEP始终未能引出,术后新发神经功能障碍。结论:多模式联合电生理监测可提高颅内动脉瘤栓塞术中脑缺血敏感性,减少动脉瘤介入治疗过程中的缺血性并发症,提高手术的安全性。
[Abstract]:Objective: to investigate the value of multimode electrophysiological monitoring in preventing cerebral ischemia during intracranial aneurysm embolization. Methods: a retrospective analysis of 44 patients undergoing endovascular embolization of intracranial aneurysms from May 2013 to June 2014 was performed and divided into two groups according to the use of intraoperative electrophysiological monitoring. The first group was 21 cases without electrophysiological monitoring during operation from May 2013 to November 2013 (referred to as unmonitored group) and the second group (23 cases from December 2013 to June 2014) using Cadwell Cascade of the United States. 32 lead intraoperative evoked potential monitoring system, According to the international EEG 10 / 20 standard, placing electrodes and setting parameters, Somatosensory evoked potential SEP, motor evoked potential (MEP), scalp electroencephalogram EGG (scalp electroencephalogram EGG) and brainstem auditory evoked potential BAEP (brainstem auditory evoked potential BAEP) were monitored according to aneurysm site and related blood supply area. All monitoring waveforms began to be guided. Set a baseline behind the catheter, The changes of electrophysiological indexes during operation were observed. On the first day after operation, as long as there was a decrease in the level of consciousness and language function or any limb muscle strength, the sensation was lower than that before the operation, that is, the patient was considered to have new neurological dysfunction. Three months after discharge, the prognosis was evaluated according to Glasgow Outcome Scale G0Sscore (5 points were regarded as good recovery). Death. Results the general data of the two groups were compared: age, sex, preoperative Hunt-Hess grade, aneurysm size, There was no significant difference in aneurysm location and number of aneurysms. There was no significant difference in the number of aneurysms (P 0.05). The incidence of new neurological impairment in electrophysiological monitoring group was 17.4% 23% on the first day after operation, and 47.6% 10 / 21% in unmonitored group. There was a significant difference between the two groups. There was significant difference between the two groups (蠂 ~ 2 / 4.623 / P 0.05; 3 months follow-up: 87.0% vs 57.1). There was a significant difference between the two groups (蠂 ~ (2 +) 4.919 / P 0.05). SEP monitoring was performed in 6 cases and MEP monitoring in 5 cases. There were no abnormal changes in electrophysiologic indexes in 3 cases and 13 cases in 3 cases, which were combined with EEG8 in scalp and BAEP in 1 case. There were no abnormal changes of electrophysiological indexes in 10 cases after operation and 4 cases with new neurological dysfunction after operation. In electrophysiological monitoring group, 9 cases of SEP and 4 cases of scalp EEG were changed during operation. Among them, 9 cases of electrophysiologic patients with cerebral ischemia were treated with appropriate measures, such as papaverine antispasmolysis, suspension of intravascular operation and adjustment of stent position. Before the coils were released, the last coil was withdrawn. Before the end of the operation, there were 3 patients with complete recovery of electrophysiological waveforms, 6 patients with incomplete recovery of the waveforms of 6 patients and 1 patients with normal SEP monitoring during operation, but the MEP of the right upper limb could not always be elicited. Postoperative new neurological dysfunction. Conclusion: Multi-mode combined electrophysiological monitoring can improve the sensitivity of cerebral ischemia during embolization of intracranial aneurysms, reduce the ischemic complications during interventional treatment of intracranial aneurysms, and improve the safety of operation.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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