急性缺血性脑卒中取栓术后预后判断的独立指标:运动诱发电位

Independent indicator of prognosis after thrombectomy in acute ischemic stroke:motor evoked potentials

目的 评价术中运动诱发电位(MEP)作为早期判断取栓术后预后的价值。方法 回顾性分析2020年8月—2021年10月于上海冬雷脑科医院神经外科进行急诊机械取栓的10例患者的临床资料。患者均为急性大血管闭塞入院,其中3例急性栓塞部位发生在大脑中动脉,7例发生在颈内动脉。所有患者均符合取栓指征,并在取栓术前及血管开通后记录双侧肢体的MEP波幅。术后半年对患者的肌力恢复情况、改良Rankin量表(mRS)的变化情况以及血管开通前后MEP波幅的变化情况进行分析。结果 血管开通后患肢MEP波幅增加幅度较基线大于50%以上,术后预后情况良好。而当血管开通后患肢MEP波幅增加幅度较基线小于10%,即使影像学上脑部灌注情况良好,患者最终预后情况仍不佳。结论 MEP能单独反映在脑组织恢复灌注情况下运动传导通路的受损情况,血管开通后患肢MEP波幅较基线平均增幅大于50%,半年后肌力恢复情况及预后普遍良好。术中电生理MEP监测能较早且准确地反映取栓术后的预后,具有较高的安全性和可行性。

Objective To explore the value of motor evoked potentials(MEP)as an early judgment of prognosis after thrombectomy.Methods The clinical data of 10 patients underwent emergency mechanical thrombectomy at Department of Neurosurgery,Shanghai Donglei Brain Hospital from August 2020 to October 2021 were analyzed retrospectively.All patients were admitted to hospital with acute large vessel occlusion,aged 36-81 years old(with an average of 62.3±16.41 years old).Among them,3 cases of acute embolism occurred in the middle cerebral artery,whilst 7 cases were occurred in the internal carotid artery.All patients met the indications for thrombectomy.The MEP amplitudes of bilateral limbs were recorded before thrombectomy and after vascular opening.Six months after surgery,the recovery of muscle strength,changes in the modified Rankin scale(mRS),and changes in MEP amplitude before and after vascular opening were analyzed.Results When the MEP amplitude of the affected limb increased by more than 50%compared with the baseline after the blood vessel was opened,the patients had the good postoperative prognosis.However,when the MEP amplitude of the affected limb increases by less than 10%compared with the baseline after vascular opening,even if the brain perfusion was good on imaging,it still had the poor final prognosis.Conclusions MEP alone can reflect the damage of the motor conduction pathway when the brain tissue is restored to perfusion.After the blood vessels are opened,when the MEP amplitude average increases by more than 50%compared with the baseline,the recovery of muscle strength and prognosis after half a year are generally good.Intraoperative MEP monitoring can reflect the prognosis after thrombectomy early and accurately,with high safety and feasibility.