摘要
目的探讨术中肌电图及脑电双频指数监测对选择性脊神经后根切断术(SPR)治疗痉挛型脑瘫的指导意义。方法对27例痉挛型脑瘫行SPR术,术中利用脑电双频(BIS)指数监测麻醉深度,将L2-S2各后根均匀分为3-5个神经束后行电刺激,并对下肢多组肌肉及肛门括约肌收缩情况进行肌电图(EMG)监测。将电刺激后肌肉反应情况分为0～4分,3-4分为异常。切断扩散范围异常的神经束,保留出现明显括约肌收缩的神经束。结果BIS指数在60～80时,电刺激强度适宜,反应适中,生命体征平稳,适宜手术操作。各后根的切断比例为44.4%-54.2%,所有患者术后痉挛均有改善,无大小便功能障碍及其他并发症。结论BIS指数监测对控制麻醉深度,维持麻醉平稳具有重要作用。术中电刺激是施行脊神经后根选择性切断的合理方法,电刺激后反应为Ⅲ-Ⅳ级者为异常小束,可根据具体情况予以切断。术中EMG监测对提高手术疗效,保护括约肌功能具有重要意义。
Objective The purpose of this study is to evaluate the effect of bispectral （BIS） index and electromyography（EMG） during selective posterior rhizotomy（SPR）. Methods There were 27 patients with spastic cerebral palsy received selective posterior rhizotomy（SPR）. The BIS index was used to monitor the depth of general anesthesia. Every root from L2 to S2 was separated into three to five rootlets, each rootlet was tested by electrical stimulation and the muscle responses of lower limbs and anal sphincter were observed visually and registered by EMG. The motor response of each rootlet was recorded and assigned a grade of 0, 1 ＋ , 2 ＋ , 3 ＋ , or 4 ＋ , rootlets assigned a Grade 3 ＋ or 4 ＋ were abnormal. Rootlets associated with an abnormal motor response such as spreading to inappropriate muscle groups or contralateral limbs were cut, while those rootlets associated with a significant sphincter response were saved. Result When the BIS index was between 60 - 80, the stimulus intensity was moderate and the response of muscular groups was fit with a steady life signs. It is not suit for operation when the BIS index was less than 60 or more than 80. Approximately 44.4% to 54.2% of rootlets were sectioned. Reduction of spasticity was observed in all the patients after SPR and no sphincter dysfunction and other complications happened. Conclusions This study indicates that BIS index is important to maintain a steady anesthesia and control the anesthesia depth. Intraopertive electric stimulation is a reasonable method for SPR, those rootlets assigned a Grade 3 ＋ or 4 ＋ is abnormal and should be sectioned according to the actual facts. Electromyography monitoring during SPR is crucial to enhance the improvements and protect the sphincter function.
出处
《中华神经外科杂志》
CSCD
北大核心
2007年第12期894-897,共4页
Chinese Journal of Neurosurgery
