异常肌反应在面神经显微血管减压术中的应用

目的 探讨异常肌反应(abnormal muscle response,AMR)监测在面神经显微血管减压术(microvascular decolnpression,MVD)中鉴别责任血管、评估减压效果以及判断预后方面的作用.方法 241例典型面肌痉挛患者接受了面神经MVD术中AMR的实时监测,并在术后1周进行疗效评估,分析术中AMR变化与手术预后之问的关系.结果 所有241例患者均在术中记录到典型AMR波形,术后第1周217例(90.0%)患者症状完全缓解.AMR消失组175例,其中165例(94.3%)症状缓解;AMR未消失组66例,52例(78 8%)症状缓解.统计学分析显示AMR消失组的疗效明显好于AMR未消失组(P<0.05).结论 术中AMR监测可辅助判断责任血管,评估减压效果,对提高手术疗效具有较高的应用价值.

Abstract：

Objective Abnormal muscle response( AMR) to the electrical stimulation of a branch of facial nerve is a specific electrophysiological feature of primary hemifacial spasm ( HFS) .Although the correlation between intraoperative AMR findings and postoperative results in patients with HFS has been investigated before, the AMR monitoring has not been employed widely during the microvascular decompression (MVD) surgery.The aim of this study was to evaluate the value of AMR monitoring during MVD, and the correlation between the AMR changes and the clinical outcome.Method This study included 241 cases of MVD.Intraoperative AMR monitoring was performed for each subject.The patients were divided into two groups based on whether the AMR wave disappeared or not following decompression of the facial nerve.Results The AMR disappeared after MVD in 175 patients.Among these 175 patients, 165(94.3% ) patients were relieved from HFS 1 week after HFS.Out of the 66 patients in whom the AMR persisted after MVD, 52(78.8%) patients were relieved.The correlation between intraoperative AMR abolition and HFS relief was statistically significant ( P < 0.05 ) .Conclusions Intraoperative AMR monitoring is an effective assistant for a successful MVD for the patient with HFS.It may be helpful in predicting outcomes in short term and identifying offending vessels,so it should be monitored routinely during MVD.     

颈动脉球囊临时阻断评估脑缺血耐受性

目的　寻找能可靠评价脑对颈动脉阻断 (TBO)耐受性的方法。方法　对 2 0例临床需要阻断颈动脉的患者 ,采用Seldinger穿刺插管法将球囊导管置入颈动脉将其临时阻断 ,其间对患者进行连续的临床评价和经颅多普勒超声图 (TCD)、颈动脉残端压 (SP)监测 ,并通过DSA检查Willis环的沟通情况。结果　除 1例置管引起颈总动脉 (CCA)闭塞 ,1例尚未阻断颈动脉即出现神经系统体征外均完成试验 ,其中 2例分别在颈动脉阻断后 34min和 2 7min因出现神经系统体征提前终止TBO ,并被认为不能耐受颈动脉阻断。其余都通过了 4 5minTBO ,他们的同侧大脑中动脉 (MCA)血流速度下降为 36 %±18% ,SP为 (5 4± 2 2 )mmHg(30～ 87)。DSA显示除 2例未完成TBO外其余受试者Willis环沟通均良好。结论　TBO方法可靠实用 ,可作为处理颈动脉的常规术前准备