中国脑血管病杂志
中國腦血管病雜誌
중국뇌혈관병잡지
CHINESE JOURNAL OF CEREBROVASCULAR DISEASES
2015年
2期
72-77
,共6页
颅内动脉瘤%栓塞,治疗性%电生理学%监测,手术中%事故预防
顱內動脈瘤%栓塞,治療性%電生理學%鑑測,手術中%事故預防
로내동맥류%전새,치료성%전생이학%감측,수술중%사고예방
Intracranial aneurysm%Embolization,therapeutic%Electrophysiology%Monitoring,intraoperative%Accident prevention
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44例颅内动脉瘤血管内介入栓塞术患者的资料，根据术中是否采用电生理监测分为两组，监测组23例，未监测组21例。按动脉瘤部位监测体感诱发电位（SEP）、运动诱发电位（MEP）、头皮脑电图及脑干听觉诱发电位（BAEP）。对比分析两组术后第1天新发神经功能缺损及3个月后随访情况。结果监测组术中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，及时采取预防措施。监测组患者术后第1天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，P<0.05）；术后两组3个月随访预后良好率比较[87.0%（20／23）比57.1%（12／21）]，差异有统计学意义（χ2=4.919，P<0.05），两组均无死亡病例。结论多模式联合电生理监测可减少动脉瘤介入治疗过程中的缺血性并发症的发生，提高手术安全性。
目的：探討多模式神經電生理鑑測在顱內動脈瘤栓塞術中預防腦缺血的價值。方法迴顧性分析2013年5月至2014年6月44例顱內動脈瘤血管內介入栓塞術患者的資料，根據術中是否採用電生理鑑測分為兩組，鑑測組23例，未鑑測組21例。按動脈瘤部位鑑測體感誘髮電位（SEP）、運動誘髮電位（MEP）、頭皮腦電圖及腦榦聽覺誘髮電位（BAEP）。對比分析兩組術後第1天新髮神經功能缺損及3箇月後隨訪情況。結果鑑測組術中SEP變化9例，MEP變化3例，頭皮EEG變化4例，對其中9例電生理顯示腦缺血患者，及時採取預防措施。鑑測組患者術後第1天新的神經功能缺損髮生率為17.4%（4／23），未鑑測組為47.6%（10／21），兩組比較差異有統計學意義（χ2=4.623，P<0.05）；術後兩組3箇月隨訪預後良好率比較[87.0%（20／23）比57.1%（12／21）]，差異有統計學意義（χ2=4.919，P<0.05），兩組均無死亡病例。結論多模式聯閤電生理鑑測可減少動脈瘤介入治療過程中的缺血性併髮癥的髮生，提高手術安全性。
목적：탐토다모식신경전생리감측재로내동맥류전새술중예방뇌결혈적개치。방법회고성분석2013년5월지2014년6월44례로내동맥류혈관내개입전새술환자적자료，근거술중시부채용전생리감측분위량조，감측조23례，미감측조21례。안동맥류부위감측체감유발전위（SEP）、운동유발전위（MEP）、두피뇌전도급뇌간은각유발전위（BAEP）。대비분석량조술후제1천신발신경공능결손급3개월후수방정황。결과감측조술중SEP변화9례，MEP변화3례，두피EEG변화4례，대기중9례전생리현시뇌결혈환자，급시채취예방조시。감측조환자술후제1천신적신경공능결손발생솔위17.4%（4／23），미감측조위47.6%（10／21），량조비교차이유통계학의의（χ2=4.623，P<0.05）；술후량조3개월수방예후량호솔비교[87.0%（20／23）비57.1%（12／21）]，차이유통계학의의（χ2=4.919，P<0.05），량조균무사망병례。결론다모식연합전생리감측가감소동맥류개입치료과정중적결혈성병발증적발생，제고수술안전성。
Objective To investigate the value of prevention of cerebral ischemia with multi-modality neuroelectrophysiological monitoring in intracranial aneurysm embolization. Methods The clinical data of 44 patients with intracranial aneurysm treated with endovascular embolization from May 2013 to June 2014 were analyzed retrospectively. The patients were divided into two groups according to whether they used intraoperative neuroelectrophysiological monitoring. There were 21 patients in a monitoring group and 21 in a non-monitoring group. According to the site of the aneurysms,somatosensory evoked potential ( SEP),motion evoked potential( MEP),scalp electroencephalogram,and brainstem auditory evoked potential (BAEP)were monitored,and at one day after procedure,their newly developed neurological deficits and the follow up observation after 3 months in both groups were compared and analyzed. Results The intraoperative SEP,MEP,and scalp EEG changes in the monitoring group were observed in 9,3 and 4 patients,respectively. Timely preventive measures were taken for 9 of the patients with cerebral ischemia revealed by neuroelectro-physiological monitoring. At the first day after procedure,the incidence of patients with new neurological deficit was 17. 4%(4/23)in the monitoring group,and that was 47. 6%(10/21)in the non-monitoring group. There was significant difference between the 2 groups(χ2 =4. 623;P<0. 05). There was significant difference in the good prognosis rates(87. 0%[20/23]vs. 57. 1%[12/21])after 3-month follow-up (χ2 =4. 919;P<0. 05)between the 2 groups. There were no deaths in both groups. Conclusion Multimode in combination with neuroelectrophysiological monitoring may decrease ischemic complications in aneurysm interventional treatment and improve the safety of procedure.
