【摘要】：目的： 提出喉返神經(jīng)監(jiān)測的新參數(shù)振幅的相對值并進行評估，希望能為甲狀腺手術(shù)喉返神經(jīng)監(jiān)測應(yīng)用提供新的定量依據(jù)，以提高神經(jīng)監(jiān)測技術(shù)的準(zhǔn)確性。 背景： 在復(fù)雜的高難度甲狀腺手術(shù)中，喉返神經(jīng)常難免發(fā)生損傷，這長期以來一直困擾著甲狀腺外科醫(yī)生。術(shù)中神經(jīng)監(jiān)測技術(shù)應(yīng)運而生并日漸完善。此項技術(shù)中，外科醫(yī)生可通過聲帶肌肌電信號變化對喉返神經(jīng)是否發(fā)生損傷，損傷部位，損傷程度及功能狀態(tài)進行及時分析，，為外科醫(yī)生在甲狀腺手術(shù)中及時判斷喉返神經(jīng)損傷提供有效保障，美國內(nèi)分泌外科（AAES）已把INOM作為手術(shù)指南加以推廣。但其準(zhǔn)確性尚有待于進一步提高，臨床應(yīng)用仍促進在爭議。 方法： 回顧性分析我院1164例甲狀腺手術(shù)患者的神經(jīng)監(jiān)測數(shù)據(jù)，對振幅、及振幅的相對值進行總結(jié)，并計算應(yīng)用不同參數(shù)時喉返神經(jīng)損傷的正確診斷率。 結(jié)論： 左右側(cè)、不同測量部位、不同測量方法（電流）、不同年齡、不同性別的振幅的相對值均無明顯差異。且喉返神經(jīng)監(jiān)測振幅的絕對值與相對值聯(lián)合使用可以將神經(jīng)監(jiān)測對于喉返神經(jīng)損傷的陽性預(yù)測值由21.57%提高至51.22%，正確診斷指數(shù)為由55.23%提高80.41%。振幅聯(lián)合相對值能有效排除左右側(cè)、測量部位、測量方法（不同電流）、年齡、性別、給測量帶來的影響，與術(shù)中神經(jīng)監(jiān)測的其他指數(shù)聯(lián)合能降低喉返神經(jīng)損傷的誤診率及漏診率，可明顯提高喉返神經(jīng)損傷的診斷率。所以我們建議將振幅的相對值作為一個監(jiān)測指標(biāo)引入甲狀腺手術(shù)的神經(jīng)監(jiān)測中來。
[Abstract]:Aim: to present and evaluate the relative amplitude of the new parameter of recurrent laryngeal nerve (RLN) monitoring in order to provide a new quantitative basis for the application of RLN monitoring in thyroid surgery so as to improve the accuracy of nerve monitoring technique. Background: laryngeal regurgitation often occurs during complex and difficult thyroid surgery, which has long plagued thyroid surgeons. Intraoperative nerve monitoring technology emerges as the times require and is becoming more and more perfect. In this technique, surgeons can analyze whether or not the recurrent laryngeal nerve is damaged, where it is, the extent of injury and the state of its function through changes in myoelectric signals of the vocal cords. In order to provide an effective guarantee for surgeons to judge the recurrent laryngeal nerve injury in time during thyroid surgery, the (AAES) of secretory surgery in the United States has promoted INOM as a surgical guide. However, its accuracy has yet to be further improved, and its clinical application is still controversial. Methods: the nerve monitoring data of 1164 patients undergoing thyroid surgery in our hospital were analyzed retrospectively. The amplitude and the relative value of amplitude were summarized. The correct diagnosis rate of recurrent laryngeal nerve injury with different parameters was calculated. Conclusion: there is no significant difference in the relative value of amplitude between left and right, different measuring position, different measuring method (current), different age, different sex. Combined use of absolute and relative values of RLN monitoring amplitude can increase the positive predictive value of RLN monitoring to 51.22% from 21.57% to 51.22%, and the correct diagnostic index of RLN from 55.23% to 80.41%. The amplitude combined relative value can effectively exclude the effects of left and right side, measuring position, measuring method (different current), age, sex, and so on, on the measurement. Combined with other indexes of nerve monitoring during operation, the misdiagnosis rate and missed diagnosis rate of recurrent laryngeal nerve injury could be reduced, and the diagnostic rate of recurrent laryngeal nerve injury could be improved obviously. Therefore, we suggest that the relative value of amplitude should be used as a monitoring index in the neural monitoring of thyroid surgery.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R653

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