术中经颅电刺激运动诱发电位监测对颅脑手术患者术后肌力的预测价值

Predictive value of intraoperative transcranial electrical stimulation motor evoked potential monitoring for postoperative limb function in patients with craniocerebral surgery

目的探讨术中经颅电刺激运动诱发电位(TES-MEP)监测对颅脑手术患者术后肌力的预测价值。方法回顾性分析2019年1月至2020年12月南京医科大学附属常州第二人民医院神经外科收治的59例术中行TES-MEP监测的颅脑手术患者,术中记录TES-MEP波幅的变化和患者术前、术后1个月的肌力情况。根据肌力变化情况分为肌力下降组和肌力未下降组。采用单因素分析和二元logistic回归分析探讨颅脑手术患者术后1个月肌力变化的影响因素。结果单因素分析结果显示,术后1个月肌力下降组的术中TES-MEP波幅不可逆下降>50%的比例(5/8)高于术后肌力未下降组(1/50)(P<0.001),术后1个月肌力下降组的术前格拉斯哥昏迷评分低于术后肌力未下降组(P<0.001);进一步行二元logistic回归分析显示,术中TES-MEP波幅的变化是颅脑手术患者术后1个月肌力变化的独立影响因素(OR:51.77,95%CI:4.07~658.96,P=0.002),TES-MEP波幅不可逆下降>50%者术后1个月的肌力会较术前下降。受试者工作特征曲线分析结果显示,以颅脑手术患者术中TES-MEP波幅的变化达50%作为报警标准,诊断术后1个月肌力变化的曲线下面积为0.803,灵敏度为0.625,特异度为0.980,阳性预测值为83.3%,阴性预测值为94.3%。结论术中TES-MEP波幅变化50%作为报警标准对颅脑手术患者术后肌力具有良好的预测价值,TES-MEP波幅不可逆下降>50%的患者术后1个月肌力会较术前下降。

Objective To investigate the predictive value of intraoperative transcranial electrical stimulation motor evoked potential(TES-MEP)monitoring for the patient′s muscle strength post craniocerebral surgery.Methods A retrospective analysis was conducted on 59 patients with craniocerebral surgery who underwent intraoperative TES-MEP monitoring from January 2019 to December 2020 in the Department of Neurosurgery,Changzhou Second People′s Hospital Affiliated to Nanjing Medical University.Changes of intraoperative TES-MEP amplitude and muscle strength before and 1 month after surgery were documented.According to the changes of muscle strength,the patients were divided into muscle strength decreased group and muscle strength non-decreased group.Univariate analysis and binary logistic regression analysis were used to explore the influencing factors of muscle strength changes at 1 month after craniocerebral surgery.Results The results of univariate analysis showed that the proportion of intraoperative TES-MEP amplitudes with an irreversible decrease of>50%in the muscle strength decreased group(5/8)at 1 month after surgery was higher than that of the postoperative muscle strength non-decreased group(1/50)(P<0.001).The preoperative Glasgow coma score in the group with decreased muscle strength at 1 month after operation was lower than that in the group without postoperative muscle strength decrease(P<0.001).Binary logistic regression analysis revealed that the intraoperative TES-MEP amplitude decrease was an independent influencing factor for muscle strength changes 1 month post surgery(OR:51.77,95%CI:4.07-658.96,P=0.002).The irreversible reduction greater than 50%in the TES-MEP amplitude predicted a decrease in muscle strength 1 month after surgery.The results of receiver operating characteristic curve analysis showed that the area under the curve for diagnosing the changes in muscle strength at 1 month after surgery was 0.803,the sensitivity was 0.625,and the specificity was 0.980.The positive predictive value was 83.3%and the negative predictive value was 94.3%.Conclusions The change of 50%in intraoperative TES-MEP amplitude as an alarm criterion has a good predictive value for postoperative limb function changes in neurosurgical patients.The irreversible decrease greater than 50%in the TES-MEP amplitude can predict a lower muscle strength 1 month after surgery than before surgery.