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诱发电位监测对预测颈内动脉动脉瘤手术术后运动状态的效果。

Efficacy of evoked potential monitoring for predicting postoperative motor status in internal carotid artery aneurysm surgeries.

机构信息

Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.

出版信息

J Clin Monit Comput. 2022 Jun;36(3):667-673. doi: 10.1007/s10877-021-00693-1. Epub 2021 Mar 23.

Abstract

This study aimed to investigate the efficacy of intraoperative motor evoked potential (MEP) and somatosensory evoked potential (SSEP) monitoring for predicting postoperative motor deficits (PMDs) in patients with internal carotid artery (ICA) aneurysms. The data for 138 patients with ICA aneurysms who underwent surgical clipping as well as their intraoperative neuromonitoring data were retrospectively reviewed. The efficacy of MEP/SSEP changes for predicting PMDs was assessed using binary logistic regression analysis. Subsequently, receiver operating characteristic curve analysis was used to obtain a supplementary critical value of the MEP/SSEP deterioration duration. The sensitivity and specificity of MEP changes for predicting PMDs were 0.824 and 0.843, respectively. For SSEP changes, the sensitivity and specificity were 0.529 and 0.959, respectively. MEP and SSEP changes were identified as independent predictors for short-term (p = 0.002 and 0.011, respectively) and long-term PMDs (p = 0.040 and 0.006, respectively). The supplementary critical value for MEP deterioration duration for predicting PMDs was 14 min (p = 0.007, AUC = 0.805). For SSEP, the value was 14.5 min (p = 0.042, AUC = 0.875). The MEP/SSEP changes adjusted by those optimal values were also identified as independent predictors for short-term (p < 0.001 and p = 0.005, respectively) and long-term PMDs (p = 0.019 and 0.003, respectively). Intraoperative MEP and SSEP deterioration durations are effective in predicting PMDs in patients with ICA aneurysms.

摘要

本研究旨在探讨术中运动诱发电位(MEP)和体感诱发电位(SSEP)监测对颈内动脉(ICA)动脉瘤患者术后运动障碍(PMD)的预测效果。回顾性分析了 138 例接受手术夹闭的 ICA 动脉瘤患者及其术中神经监测数据。采用二项逻辑回归分析评估 MEP/SSEP 变化对 PMD 的预测效果。随后,采用受试者工作特征曲线分析获得 MEP/SSEP 恶化持续时间的补充临界值。MEP 变化预测 PMD 的灵敏度和特异度分别为 0.824 和 0.843。SSEP 变化的灵敏度和特异度分别为 0.529 和 0.959。MEP 和 SSEP 变化被确定为短期(p=0.002 和 0.011)和长期 PMD(p=0.040 和 0.006)的独立预测因子。MEP 恶化持续时间预测 PMD 的补充临界值为 14 分钟(p=0.007,AUC=0.805)。对于 SSEP,该值为 14.5 分钟(p=0.042,AUC=0.875)。经这些最佳值调整后的 MEP/SSEP 变化也被确定为短期(p<0.001 和 p=0.005)和长期 PMD(p=0.019 和 p=0.003)的独立预测因子。术中 MEP 和 SSEP 恶化持续时间可有效预测 ICA 动脉瘤患者的 PMD。

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