本文選題：顱內(nèi)動(dòng)脈瘤 + 栓塞��； 參考：《石河子大學(xué)》2015年碩士論文

【摘要】：目的:探討多模式神經(jīng)電生理監(jiān)測(cè)在顱內(nèi)動(dòng)脈瘤栓塞術(shù)中預(yù)防腦缺血的價(jià)值。方法:回顧性分析2013年5月至2014年6月期間44例顱內(nèi)動(dòng)脈瘤血管內(nèi)介入栓塞術(shù)患者,根據(jù)是否應(yīng)用術(shù)中電生理監(jiān)測(cè)分為兩組,第一組為2013年5月至2013年11月術(shù)中未應(yīng)用電生理監(jiān)測(cè)21例(簡(jiǎn)稱未監(jiān)測(cè)組),第二組為2013年12月至2014年6月術(shù)中應(yīng)用電生理監(jiān)測(cè)23例(簡(jiǎn)稱監(jiān)測(cè)組),采用美國(guó)Cadwell Cascade 32導(dǎo)術(shù)中誘發(fā)電位監(jiān)護(hù)系統(tǒng),按照國(guó)際腦電10/20標(biāo)準(zhǔn),放置電極及設(shè)定參數(shù),按動(dòng)脈瘤部位及相關(guān)血供區(qū)域監(jiān)測(cè)體感誘發(fā)電位(somatosensory evoked potential SEP)、運(yùn)動(dòng)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(cè)波形均以開始置入導(dǎo)引導(dǎo)管后設(shè)置基線,觀察術(shù)中各電生理指標(biāo)變化情況。術(shù)后常規(guī)復(fù)查CT,患者術(shù)后第1天只要有意識(shí)水平及語言功能下降或任何肢體肌力、感覺比術(shù)前下降,即被認(rèn)為有新的神經(jīng)功能障礙存在,出院后3個(gè)月根據(jù)格拉斯哥預(yù)后量表(Glasgow Outcome Scale G0S)評(píng)分評(píng)價(jià)預(yù)后情況(5分視為恢復(fù)良好),對(duì)比分析兩組術(shù)后第1天新發(fā)神經(jīng)功能障礙及3個(gè)月后隨訪的預(yù)后情況(良好、致殘、死亡)。結(jié)果:(1)兩組患者一般資料比較,年齡、性別、術(shù)前Hunt-Hess分級(jí)、動(dòng)脈瘤大小、動(dòng)脈瘤部位及動(dòng)脈瘤個(gè)數(shù)比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。(2)電生理監(jiān)測(cè)組患者術(shù)后第1天出現(xiàn)新的神經(jīng)功能缺損發(fā)生率為17.4%(4/23),未監(jiān)測(cè)組為47.6%(10/21),兩組比較差異有統(tǒng)計(jì)學(xué)意義(χ2=4.623,P0.05);術(shù)后3個(gè)月隨訪預(yù)后良好率(87.0%比57.1%)組間差異有統(tǒng)計(jì)學(xué)意義(χ2=4.919,P0.05),兩組均無死亡病例。(3)監(jiān)測(cè)組23例患者中,單一行SEP監(jiān)測(cè)6例,SEP聯(lián)合MEP監(jiān)測(cè)5例,SEP聯(lián)合頭皮EEG8例,SEP聯(lián)合BAEP監(jiān)測(cè)1例,聯(lián)合應(yīng)用SEP、MEP及頭皮EEG三種模式監(jiān)測(cè)3例。13例患者術(shù)中電生理指標(biāo)無異常改變,術(shù)后無新發(fā)神經(jīng)功能障礙,10例術(shù)中電生理指標(biāo)發(fā)生異常改變,術(shù)后出現(xiàn)新的神經(jīng)功能障礙4例。電生理監(jiān)測(cè)組術(shù)中SEP變化9例,MEP變化3例,頭皮EEG變化4例,對(duì)其中9例電生理顯示腦缺血患者,及時(shí)采取相應(yīng)措施,如:罌粟堿解痙,暫停血管內(nèi)操作,調(diào)整支架位置,彈簧圈解脫前撤出最后一個(gè)彈簧圈,手術(shù)結(jié)束前有3例患者電生理波形完全恢復(fù),6例患者波形未完全恢復(fù)。1例患者術(shù)中SEP監(jiān)測(cè)正常,但是右側(cè)上肢的MEP始終未能引出,術(shù)后新發(fā)神經(jīng)功能障礙。結(jié)論:多模式聯(lián)合電生理監(jiān)測(cè)可提高顱內(nèi)動(dòng)脈瘤栓塞術(shù)中腦缺血敏感性,減少動(dòng)脈瘤介入治療過程中的缺血性并發(fā)癥,提高手術(shù)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(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1

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