Department of General and Visceral Surgery, Robert-Bosch-Hospital, Stuttgart, Germany.
Head Neck. 2011 Jul;33(7):976-84. doi: 10.1002/hed.21564. Epub 2010 Nov 10.
Continuous intraoperative neuromonitoring (CIONM) via vagal nerve stimulation (VNS) is a new option for recurrent laryngeal nerve (RLN) protection during thyroid surgery. The aim of this study was to evaluate the safety of VNS for CIONM and to assess its effects on the autonomic nervous system (ANS) through analyzing heart rate variability (HRV).
In a prospective, nonrandomized controlled study 5 patients received VNS for CIONM and 5 were operated on with conventional intermittent intraoperative neuromonitoring (IONM). HRV was analyzed in accord with patient-specific reference values.
VNS resulted in significantly altered ANS balance. Relative parasympathetic activity increased during VNS. Yet, no relevant cardiac arrhythmias or hemodynamic alterations were observed during VNS.
HRV analysis revealed a distinct impact of VNS for CIONM on ANS balance. VNS caused parasympathetic predominance that was not countered by increased sympathetic activity.
通过迷走神经刺激（VNS）进行连续术中神经监测（CIONM）是甲状腺手术中保护喉返神经（RLN）的新选择。本研究旨在评估 VNS 用于 CIONM 的安全性，并通过分析心率变异性（HRV）来评估其对自主神经系统（ANS）的影响。
在一项前瞻性、非随机对照研究中，5 例患者接受 VNS 进行 CIONM，5 例患者接受常规间断术中神经监测（IONM）进行手术。根据患者的特定参考值分析 HRV。
VNS 导致 ANS 平衡明显改变。在 VNS 期间，相对副交感神经活动增加。然而，在 VNS 期间未观察到相关的心律失常或血液动力学改变。
HRV 分析显示 VNS 对 CIONM 对 ANS 平衡有明显影响。VNS 导致副交感神经优势，而交感神经活动没有增加来对抗。
