研究中国人术中喉返神经监测肌电信号的正常值范围

目的:应用术中神经监测技术(intraoperative neuromonitoring IONM),探讨国人喉返神经肌电信号的正常值范围。方法:烟台毓璜顶医院甲状腺外科自2009年11月到2012年1月对300例甲状腺开放手术行术中喉返神经实时监测,术中一根回路电极斜行刺入同侧切口外缘直径约2 cm范围皮肤,两根记录电极斜行刺入环甲肌,手持刺激探针垂直刺激神经,发出"嘟嘟嘟"提示音,同时监测仪显示器显示肌电波形,并记录潜伏期及波幅值。结果:285例(386条)清晰显示肌电波形;15例未引出肌电波形,其中10例因机器故障和麻醉因素造成假阴性,5例因肿瘤浸润环甲肌,无法插入记录电极造成。无永久性喉返神经损伤,暂时性神经损伤2例,术后1月内恢复。V1 95%可信区间482.66～574.28μV,R1 95%可信区间521.85～615.05μV,V2 95%可信区间440.92～531.84μV,R2 95%可信区间489.25～582.05μV,T可信区间19.88～20.12ms。结论:明确喉返神经肌电信号正常值范围,为识别、确认喉返神经及通过肌电信号判断神经功能完整性提供依据,降低喉返神经损伤率,利于判断喉返神经非离端性损伤,并寻找损伤原因。

Study the Normal Range of Intraoperative Neuromonitring EMG during Thyroid Surgery

Objective: To investigate normal range of the recurrent laryngeal nerve EMG during the intraoperative nerve monitoring(IONM).Methods: There were 300 cases in the study of IONM,in the department of Thyroid Surgery,Yantai Yuhuangding Hospital from November 2009 to January 2012.In the procedure,a needle loop electrode was put in the skin obliquely,of which the diameter was 2cm in the same side,two needle recording electrode obliquely piercing the cricothyroid muscle,at the same time,hand-held to stimulate probe vertical stimulate neural issued a "toot toot" tone,the monitor display electromyographic waveforms and record the latency and amplitude values.Results: 285 cases(386 sizes) showed Electromyogram clearly,Electromyogram were not drawed out in 15 cases,while 10 were false-negative because of system and anesthesia questions,5 were needle electrodes can not put in properly.There was no permanent recurrent laryngeal never injure,2 transient nerve injure cases recovered in one month.V1 95% confidence interval:482.66～574.28 V,R1 95% confidence interval: 521.85～615.05 V,V2 95% confidence interval:440.92～531.84 V,R2 95% confidence interval:489.25～582.05 V,T 95% confidence interval is 19.88 ~ 20.12ms.Conclusion: Study the normal range of the recurrent laryngeal nerve EMG,to determine the integrity of the nerve function for a basis,reducing the rate of recurrent laryngeal nerve injury,which will help judge the recurrent laryngeal nerve injury,and look for the reasons of injury.