异常肌反应监测在显微血管减压手术治疗面肌痉挛中的应用

目的 探讨异常肌反应(AMR)监测在显微血管减压手术治疗面肌痉挛(HFS)中的作用,比较监测组与未监测组的近期和远期疗效差别.方法 234例HFS患者接受了纤微血管减压手术手术,其中AMR监测组199例,AMR未监测组35例.本研究中男68例,女166例;年龄25～76岁,平均(45.2±12.5)岁.麻醉诱导后不使用肌松剂.采取刺激面神经颧支,记录同侧颏肌电反应的方法.刺激和记录电极均使用针状电极.刺激参数恒定为:方波刺激.波宽0.1 ms,频率1 Hz,强度5～20 mA.分析AMR监测结果与术后疗效的关系,比较监测组和未监测组的疗效差异.结果 监测组患者均记录到特征性的AMR波形.术中面神经根减压后AMR消失165例(82.9%),未消失34例(17.1%),AMR消失组的疗效明显好于AMR未消失组,差异有统计学意义.监测组和未监测组疗效差异有统计学意义,监测组疗效优于未监测组.结论 AMR监测有助于鉴别责任血管,评估即刻减压效果,能够提高HFS患者的手术效果.

Abnormal muscle response monitoring as a guide during microvascular decompression for hemifacial spasm

Objective To investigate the value of abnormal muscle response (AMR) monitoringduring microvascular decompression (MVD) for hemifacial spasm (HFS) and compare the outcomes of thepatients undergoing AMR or not. Methods 234 HFS patients, aged (45.2±12.5) (25 -76), undergoingMVD were randomly divided into 2 groups:199 of them underwent AMR monitoring intra-operatively and 35not. No muscle relaxant was used. The zygomatic branch of the facial nerve was stimulated electrically and theAMR of the ipsilateral mental muscle was recorded. The relationship between AMR monitoring results andfinal surgical outcome was analyzed. Results Before incision of dura mater, all patients showedcharacteristic AMR of HFS. AMR disappeared in 165 patients ( 82.9% ) after MVD of the facial nerveroot. HFS disappeared shordy after operation in 144 of the 165 patients with disappearance of AMR, and onlyin 8 of the 34 patients with persistent AMR. Follow-up lasting for more than 1 year showed that HFSdisappeared in 157 of the 181 patients of the AMR group, and in 24 of the 35 patients who had notundergone AMR monitoring during operation. Conclusion Helping differentiate the responsible vessel, toassess the effect of decompression, and to predict the postoperative course of MVD, AMR monitoringimproves the long-term outcome of HFS treated with MVD.