听神经瘤切除术中SEP联合ABR监测对面、听神经的保护作用

A Study of the Protective Effect of SEP Combined with ABR Monitoring on Facial and Auditory Nerve During Excision of Acoustic Neuroma

戚钰;郑伟;胡正权;李娜;刘杰;

1:江苏省徐州市中心医院麻醉科

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摘要

目的探讨听神经瘤切除术中采用体感诱发电位(somatosensory evoked potential, SEP)联合听性脑干反应(auditory brainstem response, ABR)监测对面、听神经的保护作用。方法以128例听神经瘤切除术患者为研究对象，随机分为对照组(64例)和研究组(64例),对照组术中行肌电图(EMG)联合ABR监测，研究组术中采用SEP、EMG、ABR联合监测；比较两组面、听神经保护情况。结果研究组与对照组手术结束时ABR引出率(分别为78.13%、75.00%)差异无统计学意义(χ2=0.174,P=0.676),其中研究组波形分化良好率(78.00%)高于对照组(58.33%,χ2=0.174,P=0.676),其中研究组波形分化良好率(78.00%)高于对照组(58.33%,χ2=4.380,P=0.036);两组术中ABR波Ⅰ、Ⅲ、Ⅳ潜伏期及各波间期均较手术开始时延长，波Ⅴ幅值降低(均为P<0.05),手术结束后向手术开始水平恢复；研究组肿瘤全切率、面神经解剖保留率、耳蜗神经解剖保留率均高于对照组(分别为χ2=4.380,P=0.036);两组术中ABR波Ⅰ、Ⅲ、Ⅳ潜伏期及各波间期均较手术开始时延长，波Ⅴ幅值降低(均为P<0.05),手术结束后向手术开始水平恢复；研究组肿瘤全切率、面神经解剖保留率、耳蜗神经解剖保留率均高于对照组(分别为χ2=4.571,P=0.033;χ2=4.571,P=0.033;χ2=4.873,P=0.027;χ2=4.873,P=0.027;χ2=4.758,P=0.029);术后研究组面神经功能良好率(87.50%,56/64)高于对照组(70.31%,45/64)(χ2=4.758,P=0.029);术后研究组面神经功能良好率(87.50%,56/64)高于对照组(70.31%,45/64)(χ2=5.680,P=0.017);研究组New Hannover听力分级为1～2级者占术前该级患者的比例(86.0%,43/50)高于对照组(65.31%,32/49)(χ2=5.680,P=0.017);研究组New Hannover听力分级为1～2级者占术前该级患者的比例(86.0%,43/50)高于对照组(65.31%,32/49)(χ2=5.770,P=0.016)。结论听神经瘤切除术中采用SEP联合ABR监测对面、听神经可起到有效的监护作用，能够减少面、听神经功能损伤，且安全可靠。

关键词

体感诱发电位;听性脑干反应;听神经瘤;面神经

基金项目(Foundation):

作者

戚钰;郑伟;胡正权;李娜;刘杰;

参考文献

1 Marchioni D,Soloperto D,Masotto B,et al.Transcanal transpromontorial acoustic neuroma surgery:results and facial nerve outcomes[J].Otol Neurotol,2018,39(2):242-249.

2 Kalogianni K,Daffertshofer A,van der Helm FCT,et al.Disentangling somatosensory evoked potentials of the fingers:limitations and clinical potential[J].Brain Topogr,2018,31(3):498-512.

3 Gabriel LB,Vernier LS,Ferreira MIDDC,et al.Parameters for applying the brainstem auditory evoked potential with speech stimulus:systematic review[J].Int Arch Otorhinolaryngol,2018,22(4):460-468.

4 卡茨，韩德民.临床听力学[M].北京：人民卫生出版社，2006.245-247.

5 王宏利.常见颅内肿瘤[M].天津：天津科学技术出版社，2012.104-107.

6 Torihashi K,Sora S,Sato H,et al.The method for placement of an intraoperative continuous facial nerve stimulating electrode in acoustic neuroma surgery:technical note[J].Neurol Med Chir (Tokyo),2018,58(11):477-480.

7 Frigeni B,Bivona R,Foresti C,et al.Predictive value of preoperative and intraoperative neurophysiology in evaluating long-term facial function outcome in acoustic neuroma surgery [J].Otol Neurotol,2020,41(4):530-536.

8 Mac Donald DB,Dong C,Quatrale R,et al.Recommendations of the international society of intraoperative neurophysiology for intraoperative somatosensory evoked potentials[J].Clin Neurophysiol,2019,130(1):161-179.

9 Silva AG,Frizzo ACF,Garner D,et al.A relationship between brainstem auditory evoked potential and vagal control of heart rate in adult women[J].Acta Neurobiol Exp (Wars),2018,78(4):305-314.

10 Husain AM.To warn or not to warn:a reappraisal of brainstem auditory evoked potential warning criteria during surgery[J].Clin Neurophysiol,2018,129(5):1053-1055.

11 Schart-Morén N,Hallin K,Agrawal SK,et al.Peri-operative electrically evoked auditory brainstem response assessment of facial nerve/cochlea interaction at cochlear implantation[J].Cochlear Implants Int,2018,19(6):324-329.

12 洪健，韩璐，陈步东，等.经颅电刺激面神经体感诱发电位监测在大型听神经瘤切除术中的应用[J].中华神经外科杂志，2018,34(7):700-703.

13 Jalaei B,Azmi MHAM,Zakaria MN.Gender differences in binaural speech-evoked auditory brainstem response:are they clinically significant [J].Braz J Otorhinolaryngol,2019,85(4):486-493.

14 高宇，杨晶，马琳琳，等.体感诱发电位、脑干听觉诱发电位和P300检测对持续植物状态患者预后判定的应用价值[J].中华航海医学与高气压医学杂志，2019,26(5):412-415.

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