| 闵甜甜,阮娜,徐勇.神经电生理监测在脊柱侧弯三维矫形手术中的相关护理应用.骨科,2020,11(1): 78-81. |
| 神经电生理监测在脊柱侧弯三维矫形手术中的相关护理应用 |
| Nursing application of neuroelectrophysiological monitoring in three-dimensional orthopaedic surgical operation of spinal bend |
| 投稿时间：2019-02-17 |
| DOI：10.3969/j.issn.1674-8573.2020.01.015 |
| 中文关键词: 神经电生理监测 脊柱侧弯 护理 |
| 英文关键词: Neuroelectrophysiological monitoring Spinal lateral bending Nursing |
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| 中文摘要: |
| 目的 探讨神经电生理监测技术在脊柱侧弯三维矫形术中的护理应用，总结神经电生理监测技术应用于围手术期的护理经验。方法 选取我科2016年6月至2018年6月脊柱侧弯三维矫形术中应用体感诱发电位（SEP）、运动诱发电位（MEP）和自由肌电图（FEMG）的多模式神经电生理监测技术的50例病人为研究对象，围手术期结合神经电生理监测技术制定详细的护理方案，观察术中神经电生理监测不良事件和并发症的发生情况。结果 50例病人术中发生电灼伤和Ⅱ期压力性损伤各1例，术后采取相应的护理措施，均治愈。术中神经电生理监测异常电位报警4例，其中3例矫形过程中双下肢SEP下降50%~70%，及时提醒术者后暂停手术，改变手术方案，待SEP稍恢复后继续手术，术后神经功能基本恢复正常；1例SEP波幅下降70%~90%，潜伏期延长50%，MEP波形消失。预警后采取紧急处理，未见明显好转，术后病人脐平面以下感觉、运动消失，采取高压氧疗和营养神经等对症治疗，下肢肌力未见明显变化，现仍处于恢复期。结论 术中多模式神经电生理监测技术的应用能有效地预防脊柱侧弯三维矫形手术的并发症。在应用多模式神经电生理监测的同时，更需要整个医护团队科学的配合。 |
| 英文摘要: |
| Objective To investigate the nursing application of intraoperative neuroelectrophysiological monitoring technique in three-dimensional scoliosis and summarize the nursing experience of neuroelectro-physiological monitoring specialty. Methods From June 2016 to June 2018, the clinical data of 50 cases undergoing the multi-mode neuroelectrophysiological monitoring technology of somatosensory evoked potential (SEP), motor evoked potential (MEP) and free electromyography (FEMG) during three-dimensional orthopaedic surgical operation of spinal bend were selected. During the perioperative period, combined with neuroelectrophysiological monitoring technology, a detailed nursing plan was made and the adverse events of intraoperative electrophysiological monitoring and postoperative complications were observed. Results There were one case of electric burn and one case of stage Ⅱ pressure injury in 50 patients, who were cured by corresponding nursing measures. During the operation, the abnormal potentials of neuroelectrophysiological monitoring were alarmed in 4 cases, of which the SEP of both lower limbs decreased by 50%-70% in 3 cases during the orthopedic process. The operator was reminded to suspend the operation and change the operation plan in time. After the SEP recovered slightly, the operation continued, and the neurological function basically recovered. In one case, the amplitude of SEP decreased by 70%-90% and the latent period prolonged by 50%, the MEP waveform disappeared. After early warning, emergency treatment was taken and no obvious improvement was found. After operation, the sensation and movement of the patient under the umbilicus plane disappeared. Hyperbaric oxygen therapy and nutritional nerve therapy were used for symptomatic treatment. The muscle strength of the lower extremity did not change significantly, and the patient is still in the recovery period. Conclusion The application of intraoperative multimodal neuroelectrophysiological monitoring technology can effectively prevent the complications of scoliosis, and it needs the scientific cooperation of the whole medical team at the same time. |
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