干扰电位在甲状腺手术术中神经监测的应用研究

发布时间：2019-03-01 09:04

【摘要】：目的：提出喉返神经监测的新参数振幅的相对值并进行评估，希望能为甲状腺手术喉返神经监测应用提供新的定量依据，以提高神经监测技术的准确性。背景：在复杂的高难度甲状腺手术中，喉返神经常难免发生损伤，这长期以来一直困扰着甲状腺外科医生。术中神经监测技术应运而生并日渐完善。此项技术中，外科医生可通过声带肌肌电信号变化对喉返神经是否发生损伤，损伤部位，损伤程度及功能状态进行及时分析，，为外科医生在甲状腺手术中及时判断喉返神经损伤提供有效保障，美国内分泌外科（AAES）已把INOM作为手术指南加以推广。但其准确性尚有待于进一步提高，临床应用仍促进在争议。方法：回顾性分析我院1164例甲状腺手术患者的神经监测数据，对振幅、及振幅的相对值进行总结，并计算应用不同参数时喉返神经损伤的正确诊断率。结论：左右侧、不同测量部位、不同测量方法（电流）、不同年龄、不同性别的振幅的相对值均无明显差异。且喉返神经监测振幅的绝对值与相对值联合使用可以将神经监测对于喉返神经损伤的阳性预测值由21.57%提高至51.22%，正确诊断指数为由55.23%提高80.41%。振幅联合相对值能有效排除左右侧、测量部位、测量方法（不同电流）、年龄、性别、给测量带来的影响，与术中神经监测的其他指数联合能降低喉返神经损伤的误诊率及漏诊率，可明显提高喉返神经损伤的诊断率。所以我们建议将振幅的相对值作为一个监测指标引入甲状腺手术的神经监测中来。
[Abstract]:Aim: to present and evaluate the relative amplitude of the new parameter of recurrent laryngeal nerve (RLN) monitoring in order to provide a new quantitative basis for the application of RLN monitoring in thyroid surgery so as to improve the accuracy of nerve monitoring technique. Background: laryngeal regurgitation often occurs during complex and difficult thyroid surgery, which has long plagued thyroid surgeons. Intraoperative nerve monitoring technology emerges as the times require and is becoming more and more perfect. In this technique, surgeons can analyze whether or not the recurrent laryngeal nerve is damaged, where it is, the extent of injury and the state of its function through changes in myoelectric signals of the vocal cords. In order to provide an effective guarantee for surgeons to judge the recurrent laryngeal nerve injury in time during thyroid surgery, the (AAES) of secretory surgery in the United States has promoted INOM as a surgical guide. However, its accuracy has yet to be further improved, and its clinical application is still controversial. Methods: the nerve monitoring data of 1164 patients undergoing thyroid surgery in our hospital were analyzed retrospectively. The amplitude and the relative value of amplitude were summarized. The correct diagnosis rate of recurrent laryngeal nerve injury with different parameters was calculated. Conclusion: there is no significant difference in the relative value of amplitude between left and right, different measuring position, different measuring method (current), different age, different sex. Combined use of absolute and relative values of RLN monitoring amplitude can increase the positive predictive value of RLN monitoring to 51.22% from 21.57% to 51.22%, and the correct diagnostic index of RLN from 55.23% to 80.41%. The amplitude combined relative value can effectively exclude the effects of left and right side, measuring position, measuring method (different current), age, sex, and so on, on the measurement. Combined with other indexes of nerve monitoring during operation, the misdiagnosis rate and missed diagnosis rate of recurrent laryngeal nerve injury could be reduced, and the diagnostic rate of recurrent laryngeal nerve injury could be improved obviously. Therefore, we suggest that the relative value of amplitude should be used as a monitoring index in the neural monitoring of thyroid surgery.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

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