摘要
目的探究听神经瘤切除术中使用神经监测护理对面神经功能的远期影响。方法 2013-01—2015-06确诊为听神经瘤Ⅳ期18例患者纳入研究,所有患者行彻底手术切除,术中采用神经生理监测护理;使用House-Brackman(HB)评分系统进行面神经的功能评价,其中HBⅠ/Ⅱ级患者归为面神经功能良好组,Ⅲ~Ⅳ级归为功能不佳组,随访时间为1a。结果术后1a随访显示,面神经功能良好者8例,而功能预后不佳患者10例;预后较差与预后良好相比,延迟时间显著增加(P=0.041),并且近端的振幅显著降低(P=0.038),近端与远端的振幅比率偏低(P=0.039);振幅比评估预后较差的截止值为0.45、0.21,其灵敏度为72%、45%,特异性为81%、100%。结论听神经瘤切除术后面神经远期功能较差的预测因子包括较低的近端振幅及近远端的振幅比,对于体积较大的Ⅳ期肿瘤特异性更强;术中高效、规范的护理对神经电生理监测的准确、顺利进行至关重要。
Objective To investigate the long term effect of neural monitoring on facial nerve function during resection of acoustic neuroma.Methods Eighteen patients form January 2013 to June 2015 diagnosed as stageⅣof acoustic neuroma were enrolled in the study.All patients underwent radical surgery and neurophysiological monitoring and nursing.The house Brackman(HB)scoring system was used to evaluate facial nerve function.Patients with HBⅠ/Ⅱgrade were classified as those with good facial nerve function,and those with gradeⅢⅣwere classified as poorly functioned.The follow up period was 1 year.Results One year follow up showed that 8 patients had good facial nerve function,and 10 patients had poor functional prognosis.The prognosis was poor and the prognosis was good,the delay time was significantly increased(P=0.041),and the amplitude of the proximal end was significant.Decreased(P=0.038),the amplitude ratio of the proximal and distal ends was low(P=0.039);the cutoff value of the amplitude ratio was poorer to evaluate the prognosis was 0.45,0.21,the sensitivity was 72%and 45%,and the specificity was 81%and 100%.Conclusion Predictors with poor long term facial nerve function after acoustic neuroma resection include lower proximal amplitude and near distal amplitude ratio,which are more specific for largerⅣstage tumors;intraoperatively efficient,standardized care pairs.The accurate and smooth progress of neurophysiological monitoring is crucial.
作者
徐静
王晓辉
胡亚平
XU Jing;WANG Xiaohui;HU Yaping(Department of Operation Room,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China)
出处
《中国实用神经疾病杂志》
2018年第13期1489-1493,共5页
Chinese Journal of Practical Nervous Diseases
基金
河南省自然科学基金
编号:U1404822
关键词
听神经瘤
面神经
神经监测
护理
远期预后
Acoustic neuroma
Facial nerve
Intracranial tumor
Neurophysiological monitoring
Long term prognosis
