甲状软骨单针记录电极在甲状腺术中神经监测中的应用

Application of thyroid cartilage single needle recording electrode in intraoperative nerve monitoring of thyroid surgery

目的在甲状腺手术中应用甲状软骨单针记录电极监测神经功能,对比导管(ET)表面电极,探讨该电极的监测可靠性、风险预警性、应用稳定性。方法对吉林大学中日联谊医院2018年12月至2019年4月共136例甲状腺手术中涉及的182条神经行标准化监测,单针电极与监测导管电极同时记录肌电信号(EMG)参数,对比验证单针电极获得的EMG参数特点、神经损伤预警功能以及监测稳定性。结果V1信号中单针电极振幅(2048±706)μV>ET电极振幅(890±406)μV,R1信号平均振幅(2736±882)μV>(1563±560)μV(n=182,迷走神经:t=34.078,P<0.05;喉返神经:t=27.063,P<0.05),潜伏期与ET电极差异无统计学意义(右侧迷走神经:t=-1.578,P>0.05;左侧迷走神经:t=-2.868,P>0.05;喉返神经:t=-3.276,P>0.05);ET表面电极中位恢复时间为4 min(2~8 min),单针电极中位恢复时间为5 min(3~9 min);8例ET电极出现假阳性结果病例中单针电极工作如常。结论单针电极具有与ET电极相同的监测功能和效果,且接收振幅显著,信号稳定,无假阳性结果干扰。

Objective To investigate the reliability,risk warning and application stability of thyroid cartilage single needle recording electrode in thyroid surgery.Methods 182 nerves involved in 136 cases of thyroid surgery were monitored in China-Japan Union Hospital of Jilin University from December 2018 to April 2019.The parameters of EMG(electromyography)were recorded simultaneously by single needle electrode and monitoring catheter electrode.The characteristics of EMG parameters,early warning function of nerve injury and monitoring stability of single needle electrode were compared and verified.Results The amplitude of single needle electrode was detected in V1 signal The average amplitude of R1 signal was(2736±882)μV>(1563±560)μV(n=182,Vagus:t=34.078,P<0.05;RLN:t=27.063,P<0.05).There was no statistically significant difference between the incubation period and the ET electrode(Right vagus:t=-1.578,P>0.05;left vagus:t=-2.868,P>0.05;RLN:t=-3.276,P>0.05).The median recovery time of ET surface electrode was 4 min(2-8 min),and the median recovery time of single needle electrode was 5 min(3-9 min);the median recovery time of single needle electrode was 5 min(3-9 min)and the median recovery time of ET surface electrode was 4 min(2-8 min)The needle electrode works as usual.Conclusion The single needle electrode has the same monitoring function and effect as the ET electrode,with significant receiving amplitude,stable signal and no interference of false positive results.