Wu Tian,Su Jun,Li Hao,et al.Application of neurophysiological monitoring in spinal canal space-occupying disease surgery in children[J].Journal of Clinical Pediatric Surgery,2022,21(10):923-928.[doi:10.3760/cma.j.cn101785-202204097-005]
神经电生理监测在儿童椎管内占位性疾病手术中的应用
- Title:
- Application of neurophysiological monitoring in spinal canal space-occupying disease surgery in children
- 摘要:
- 目的 探讨神经电生理监测用于儿童椎管内占位性疾病手术中对脊髓及神经根功能损伤的预警作用。方法 回顾性分析2019年1月至2022年4月湖南省儿童医院神经外科收治的75例椎管内占位性疾病患儿的临床资料。将75例患儿按年龄分为三组:1岁以下组32例,1~3岁组13例,3岁以上组30例。患儿术中均使用神经电生理监测。术后14 d评估所有患儿排便、排尿功能以及肢体活动功能,判断术中监测情况与术后症状变化的相关性。结果 3岁以上组患儿体感诱发电位(somatosensory evoked potential,SSEP)及经颅电刺激运动诱发电位(transcranial electrical motor evoked potential,TCeMEP)的基线建立均高于1岁以下组及1~3岁组患儿(P<0.05)。术中TCeMEP波幅异常率为15.7%(9/57),SSEP波幅异常率为26.4%(9/34),其中1例与中心静脉压降低相关,2例与麻醉相关,经对症处理后波幅恢复至基线水平;6例与术中操作相关,其中2例停止操作并进一步处理后波幅恢复至基线水平;剩余4例术后出现肌力下降,伴有局部肢体麻木和疼痛等表现,予对症处理,术后14 d症状逐步缓解。结论 TCeMEP和SSEP在儿童(特别是3岁以上患儿)椎管内手术中具有很好的临床应用价值,监测指标变化能及时发现手术操作造成的神经组织损伤,通过合理调整操作策略可以有效减少神经功能的不可逆损害。
- Abstract:
- Objective To explore the early warning effect of intraoperative neurophysiological monitoring on spinal cord and nerve root functional injury in children with intraspinal space-occupying diseases.Methods From January 2019 to April 2022,retrospective review was performed for clinical data of 75 children hospitalized with space-occupying disease in spinal canal at Hunan Children’s Hospital.They were divided into three age groups of<1 year (A,n=32),1-3 year (B,n=13) and >3 year (C,n=30).Neurophysiological monitoring was applied intraoperatively.Defecation,urination and limb function were evaluated at Day 14 post-operation and the correlation was examined between intraoperative monitoring and postoperative symptom changes.Results The baseline values of somatosensory evoked potential (SSEP) and transcranial electrical motor evoked potential (TCeMEP) in group C were higher than those of group A/B (P<0.05).Intraoperative abnormal amplitude of TCeMEP was 15.7%(9/57) and abnormal amplitude of SSEP 26.4%(9/34).It was correlated a decline of central venous pressure (n=1) and anesthesia (n=2).Amplitude recovered after symptomatic treatment.Six cases were correlated with intraoperative handling operation.Two of them stopped operation and amplitude normalized after further treatment.The remaining 4 cases showed lower muscle strength accompanied by local limb numbness and pain.Symptoms gradually improved within 14 days post-operation.Conclusion TCeMEP and SSEP offer excellent clinical application values for intraspinal surgery in children,especially those aged over 3 years.Changes in monitoring parameters hint at nerve damage caused by surgical procedures and can effectively minimize irreversible damage to nerve function.
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备注/Memo
收稿日期:2022-4-30。
基金项目:湖南省出生缺陷协同防治科技重大专项(2019SK1010)
通讯作者:吴水华,Email:292454021@qq.com