摘要
背景:近几十年术中神经电生理监测技术发展迅速,已成为神经外科、脊柱外科和手足外科等学科手术时不可或缺的一部分。合理应用术中神经电生理监测技术可以减少或避免术中对脊髓或神经根的损伤,但术中神经电生理监测技术的影响因素诸多,这些因素会对监测的准确性产生影响,导致监测结果的异常。目的:综述脊柱外科术中神经电生理监测机制和影响因素的研究现状。方法:检索PubMed数据库及CNKI中国期刊全文数据库等收录的有关脊柱外科术中神经电生理监测机制及术中神经电生理监测影响因素的文章。英文检索词为"neurophysiologicmonitoring,somatosensory evoked potential,motor evoked potential,electromyogram,propofol,muscle relaxants";中文检索词为"术中神经电生理监测,脊柱外科手术,体感诱发电位,运动诱发电位,肌电图,丙泊酚,肌松剂"。纳入与脊柱外科术中神经电生理监测技术及神经电生理监测影响因素相关性高的文献共计52篇。结果与结论:①对近年来脊柱外科术中神经电生理监护的研究进展及神经电生理监测的影响因素进行调查,发现对脊柱外科术中神经电生理监测机制及神经电生理各方面影响因素的研究较少,而关于单一影响因素的文献有限,但各研究直接关联性较大;②脊柱外科术中神经电生理监测技术目前已成熟且广泛应用于临床,该技术可以大幅度降低术中神经损伤的风险,但其影响因素众多,会对监测结果造成不良影响,影响手术进程及结果;③了解并对相关因素采取措施,可以提高术中神经电生理监测的准确性,降低神经损伤的风险。
BACKGROUND: In recent decades, intraoperative neurophysiological monitoring technology has become an indispensable part in neurosurgery surgery, spine surgery and hand and foot surgery with rapid development. Proper use of intraoperative neurophysiological monitoring can reduce or avoid nerve injury intraoperatively. But there are many influencing factors of intraoperative neurophysiological monitoring technique, which will affect the accuracy of monitoring and lead to abnormal monitoring results.OBJECTIVE: To summarize the research status of mechanism and influencing factors of neurophysiological monitoring in spinal surgery.METHODS: The articles addressing the mechanism and influencing factors in intraoperative neurophysiological monitoring during spine surgery were retrieved in PubMed and CNKI databases. The keywords were "neurophysiologic monitoring, somatosensory evoked potential, motor evoked potential, electromyogram, propofol, muscle relaxants" in English and Chinese, respectively. A total of 52 eligible articles were included.RESULTS AND CONCLUSION:(1) The research progress of neurophysiological monitoring during spinal surgery and the influencing factors of neurophysiologic monitoring have been investigated in recent years. It is found that there are few studies on the mechanism and the influencing factors of neurophysiological monitoring during spinal surgery, but the literature concerning single factor is few, but the direct correlation of each study is closed.(2) Neurophysiological monitoring in spinal surgery is mature and widely used in clinical practice, which can significantly reduce the risk of intraoperative nerve injury. However, there are many influencing factors, which may have adverse effects on the monitoring results and affecting the surgical process and results.(3) Understanding the related factors and taking measures can improve the accuracy of intraoperative neurophysiological monitoring and reduce the risk of nerve injury.
引文
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