本文選題：顱內動脈瘤 + 栓塞��； 參考：《石河子大學》2015年碩士論文

【摘要】：目的:探討多模式神經電生理監(jiān)測在顱內動脈瘤栓塞術中預防腦缺血的價值。方法:回顧性分析2013年5月至2014年6月期間44例顱內動脈瘤血管內介入栓塞術患者,根據是否應用術中電生理監(jiān)測分為兩組,第一組為2013年5月至2013年11月術中未應用電生理監(jiān)測21例(簡稱未監(jiān)測組),第二組為2013年12月至2014年6月術中應用電生理監(jiān)測23例(簡稱監(jiān)測組),采用美國Cadwell Cascade 32導術中誘發(fā)電位監(jiān)護系統,按照國際腦電10/20標準,放置電極及設定參數,按動脈瘤部位及相關血供區(qū)域監(jiān)測體感誘發(fā)電位(somatosensory evoked potential SEP)、運動誘發(fā)電位(motion evoked potential MEP)、頭皮腦電(scalp electroencephalogram EEG)及腦干聽覺誘發(fā)電位(brainstem auditory evoked potential BAEP),各種監(jiān)測波形均以開始置入導引導管后設置基線,觀察術中各電生理指標變化情況。術后常規(guī)復查CT,患者術后第1天只要有意識水平及語言功能下降或任何肢體肌力、感覺比術前下降,即被認為有新的神經功能障礙存在,出院后3個月根據格拉斯哥預后量表(Glasgow Outcome Scale G0S)評分評價預后情況(5分視為恢復良好),對比分析兩組術后第1天新發(fā)神經功能障礙及3個月后隨訪的預后情況(良好、致殘、死亡)。結果:(1)兩組患者一般資料比較,年齡、性別、術前Hunt-Hess分級、動脈瘤大小、動脈瘤部位及動脈瘤個數比較差異均無統計學意義(P0.05),具有可比性。(2)電生理監(jiān)測組患者術后第1天出現新的神經功能缺損發(fā)生率為17.4%(4/23),未監(jiān)測組為47.6%(10/21),兩組比較差異有統計學意義(χ2=4.623,P0.05);術后3個月隨訪預后良好率(87.0%比57.1%)組間差異有統計學意義(χ2=4.919,P0.05),兩組均無死亡病例。(3)監(jiān)測組23例患者中,單一行SEP監(jiān)測6例,SEP聯合MEP監(jiān)測5例,SEP聯合頭皮EEG8例,SEP聯合BAEP監(jiān)測1例,聯合應用SEP、MEP及頭皮EEG三種模式監(jiān)測3例。13例患者術中電生理指標無異常改變,術后無新發(fā)神經功能障礙,10例術中電生理指標發(fā)生異常改變,術后出現新的神經功能障礙4例。電生理監(jiān)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,及時采取相應措施,如:罌粟堿解痙,暫停血管內操作,調整支架位置,彈簧圈解脫前撤出最后一個彈簧圈,手術結束前有3例患者電生理波形完全恢復,6例患者波形未完全恢復。1例患者術中SEP監(jiān)測正常,但是右側上肢的MEP始終未能引出,術后新發(fā)神經功能障礙。結論:多模式聯合電生理監(jiān)測可提高顱內動脈瘤栓塞術中腦缺血敏感性,減少動脈瘤介入治療過程中的缺血性并發(fā)癥,提高手術的安全性。
[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.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.1

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本文編號：1875519