脑皮层电图监测在难治性癫痫手术中的应用与护理

Application and care of electrocorticography monitoring in intractable epilepsy surgery

目的：探讨脑皮层电图（EcoG）监测在指导难治性癫痫手术中的应用价值，分析该术式的护理措施。方法：选择我院收治的难治性癫痫患者13例为研究对象，术前采用影像学、症状学和电生理学进行评估，术中应用EcoG精确定位引导切除范围。比较术前评估结果与术中EcoG探查情况，观察患者术后一般情况，评价护理效果，术后随访1个月～5年，记录并发症发生情况，采用Engel疗效分级标准评价疗效。结果：本组13例患者术中EcoG探查结果与术前评估结果基本一致，但术中EcoG探查定位更加精细准确，更有利于指导切除范围；术后发生失语、头皮下感染、复视和记忆力障碍的各l例，均在相应的处理后好转，无患者死亡；Engd分级I级的8例，Ⅱ级的3例，Ⅲ级的1例，Ⅳ级的1例，有效率为92．31％；护理质量评分为（91．34±2．26）分，患者对护理的满意度评分为（89．37±4．71）分。结论：脑皮层电图监测在难治性癫痫手术中可精确引导手术切除范围，应给予全面的围手术期护理配合。

Objective ： To explore the application value of electrocorticography （EcoG） monitoring in guidance of intractable epilepsy surgery, and analyze the nursing measures of the surgery. Methods：Selected 13 intractable epilepsy patients of our hospital as research object, assessed them with iconography, symptomatology and electrophysiology before the surgery, used EcoG to accurately locate and guide the resection range during the surgery. Compared assess- ment results before surgery and intraoperative EcoG detection condition, observed patients＇ general postoperative condition, assessed nursing effects, fol- lowed up patients for 1 month - 5 years after the surgery, recorded the complication occurrence condition and assessed treatment effects with Engel efficacy grading standard. Results：The intraoporative detection results of the 13 patients were roughly the same as the assessment results before the surgery, but the EcoG detection location in the surgery was more elaborated and accurate, which was more beneficial for guiding resection range; after the surgery, there was one patient suffering aphasia, infection under the scalp, diplopia and memory barrier respectively, but all of them got better after corresponding processing, without any patient death; in Engel grading, there were 8 grade I patients, 3 grade II patients, 1 grade III patient and lgrade IV, with effective rate of 92.31% ; the nursing quality score was （91.34±2.26） points, patients＇satisfaction scores towards nursing was （89.37±4.71 ） points. Conclusion：Elec- troeorticography monitoring can accurately guide the surgery resection range in intractable epilepsy surgery, to which a comprehensive perioperative nursing cooperation should be given.