同步视频监测侧方扩散反应在面肌痉挛手术中的应用

目的探讨显微血管减压术(microvascular decompression,MVD)治疗面肌痉挛术中应用同步视频监测侧方扩散反应(lateral spread response,LSR)的意义。方法回顾性分析105例行MVD且术中实施同步视频LSR监测的面肌痉挛病人的临床资料。分别将依据术中LSR监测及同步视频LSR监测预测术后痉挛缓解情况的结果与术后临床观察结果进行比较,分析两种方法在术后预测痉挛缓解情况方面的优劣性。结果经Kappa一致性检验分析:术中LSR监测与临床观察结果比较,在术后1周和1个月为中等一致(K1周=0.565,K1月=0.467),术后6个月一致性差(K=0.326);同步视频LSR监测与临床观察结果比较,术后1周和1个月为中等一致(K1周=0.533,K1月=0.580),术后6个月高度一致(K=0.753)。比较术后6个月的预测结果,在敏感性及特异性方面,同步视频LSR监测优于LSR监测。105例术后1周、1个月、6个月痉挛缓解良好率分别为71.14%、81.90%、87.62%。结论在MVD术中应用同步视频LSR监测对判断病人预后更有指导意义。

Application of synchronous video monitoring of lateral spread response in surgery for hemifacial spasm

Objective To investigate the significance of applying synchronous video monitoring of lateral spread response(LSR)in microvascular decompression(MVD)for hemifacial spasm(HFS).Methods Clinical data of 105 HFS patients receiving MVD and intraoperative synchronous video LSR monitoring were analyzed retrospectively.The postoperative spasm relief based on intraoperative LSR monitoring and synchronous video LSR monitoring was compared with the clinical observation results after surgery respectively.Then,the advantages and disadvantages of the two methods in predicting spasm relief after surgery were analyzed.Results It was analyzed by kappa consistency test,the results of LSR monitoring and the clinical observation showed moderate consistency in 1 week after surgery(K=0.565)and 1 month after surgery(K=0.467),and poor consistency in 6 month after surgery(K=0.326);while the results between Synchronous video LSR monitoring and the clinical observation revealed moderade consistency in 1 week after surgery(K=0.533)and 1 month after surgery(K=0.580),and high consistency in 6 months after surgery(K=0.753).In the aspect of sensitivity and specificity,the synchronous video LSR monitoring was superior to LSR monitoring according to the prediction results in 6 months after surgery.The rate of good spasm relif in 105 patients were 71.14%,81.90%,87.62%respectively in 1 week,1 month and 6 months after surgery.Conclusion The application of synchronous video LSR monitoring during MVD is more conducive to judging patients'clinical prognosis.