脑干听觉诱发电位在后颅窝恶性肿瘤手术干预中的价值研究

VALUE OF BRAINSTEM AUDITORY EVOKED POTENTIALS IN SURGICAL INTERVENTION OF POSTERIOR FOSSA MALIGNANT TUMOR

目的探讨脑干听觉诱发电位在后颅窝恶性肿瘤手术干预中的临床价值。方法前瞻性选择2015年6月—2018年6月海南省人民医院收治的后颅窝肿瘤实施手术治疗患者40例作为观察组;另选取同期颅内肿瘤(非后颅窝肿瘤)手术治疗者40例作为对照组。所有患者均行脑干听觉诱发电位监测,统计二组不同时间点(术前、麻醉后、手术操作时、手术结束时)脑干听觉诱发电位(Ⅰ波、Ⅲ波、Ⅴ波)潜伏期和波幅变化情况;比较观察组后颅窝肿瘤操作过程中脑干听觉诱发电位不同主波潜伏期及波幅变化;分析观察组后颅窝肿瘤操作时间与脑干听觉诱发电位Ⅴ波潜伏期及波幅的相关性,并统计其术后并发症发生情况。结果观察组脑干听觉诱发电位Ⅰ波、Ⅲ波及Ⅴ波潜伏期均显著高于进行肿瘤操作时的对照组(P<0.05),波幅均显著低于进行肿瘤操作时的对照组(P<0.05);Ⅴ波潜伏期长于Ⅰ波及Ⅲ波(P<0.05),波幅低于Ⅰ波及Ⅲ波(P<0.05),操作时间与Ⅴ波的潜伏期呈正相关,与波幅呈负相关(P<0.05);观察组40例患者未见明显并发症。结论针对脑干肿瘤患者,实施脑干听觉诱发电位监测,根据Ⅴ波潜伏期与波幅的变化,能有效、准确地指引手术操作,提高手术精确度与准确性,确保手术安全。

Objective To investigate the clinical value of brainstem auditory evoked potentials in surgical intervention of posterior fossa malignant tumors.Methods Forty patients with posterior fossa tumors admitted to Hainan People’s Hospital from June 2015 to June 2018 for surgical treatment were prospectively selected as the observation group,and forty patients with intracranial tumors(non-posterior fossa tumors)during the same period for surgical treatment were selected as the control group.All patients with brainstem auditory evoked potential monitoring,statistical different time points in the two groups(preoperative,after anesthesia,surgical operation,surgical)at the end of the brainstem auditory evoked potential(Ⅰwave,Ⅲwave andⅤwave)latency and amplitude changes.The latency and amplitude of brainstem auditory evoked potential were compared during the operation of posterior fossa tumor in the observation group.Analysis of observation group of posterior fossa tumor operation time and brainstem auditory evoked potentialⅤwave incubation period and amplitude of correlation,and statistics of the postoperative complications.Results The incubation periods ofⅠwave,Ⅲwave andⅤwave in the observation group were significantly higher than those in the control group(P<0.05),and the amplitude of the wave was significantly lower than that in the control group(P<0.05).The latency ofⅤwave was longer thanⅠwave andⅢwave(P<0.05),but the amplitude was lower thanⅠwave andⅢwave(P<0.05).The latency ofⅤwave was positively correlated with the operation time,but negatively correlated with the amplitude(P<0.05).No obvious complications were observed in 40 patients in the observation group.Conclusion For brain stem tumor patients and the implementation of brainstem auditory evoked potential monitoring,according to the change ofⅤwave incubation period and amplitude,can effective and accurate operation,the direction of improve the precision and accuracy,and ensure the operation safety.