Evoked electromyographic technique for quantitative assessment of the innervation status of laryngeal muscles.
Evoked electromyographic technique for quantitative assessment of the innervation status of laryngeal muscles.
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诱发肌电图技术用于定量评估喉部肌肉的神经支配状态。
DOI：
10.1177/000348940511400713
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Garren,Kurt
中科院分区：
文献类型：
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作者：
Zealear,DavidL;Swelstad,MatthewR;Fortune,Scott;Rodriguez,RicardoJ;Chung,Sung-Min;Valyi-Nagy,Klara;Billante,MarkJ;Billante,CherylR;Garren,Kurt
本研究的目的是建立一种微创、非损伤性的诱发肌电技术，能够准确地量化喉返神经刺激对喉肌的支配水平。方法在24只犬身上进行了四个阶段的研究，包括1)最佳刺激记录形态的确定，2)敏感性和准确性的统计分析，3)安全性评价，4)喉肌(S)对诱发反应的识别。结果表明，完全无创的技术是不可行的。刺激阴极必须是侵入性的，以确保喉返神经的离散激活，而两个记录电极应保持在表面，其中一个覆盖在甲状旁侧。这种构型被证明是非常准确的，错误率只有6%到7%，而且灵敏度足以在神经中检测到不到1%的轴突完整的信号。在350次刺激针的穿透过程中，没有任何动物的神经损伤的证据。应用神经肌肉阻滞剂识别产生表面肌反应的肌肉，发现甲状旁肌是产生表面肌反应的主要来源，而环踝后肌未被累及。结论这种诱发肌电技术可以提供有关喉麻痹患者失神经支配和再生时肌肉神经支配程度的定量信息。
ObjectivesThe purpose of this study was to develop a minimally invasive, noninjurious evoked electromyographic technique that could accurately quantitate the level of innervation of laryngeal muscles with recurrent laryngeal nerve stimulation.MethodsA four-phase study was conducted in 24 canines, including 1) identification of the best stimulation-recording configuration, 2) statistical analysis of sensitivity and accuracy, 3) evaluation of safety, and 4) identification of the laryngeal muscle(s) that contribute to the evoked response.ResultsThe results demonstrated that an entirely noninvasive technique is not feasible. The stimulating cathode must be invasive to ensure discrete activation of the recurrent laryngeal nerve, whereas both recording electrodes should remain on the surface with one overlying the thyroid ala. This configuration proved to be highly accurate, with an error rate of only 6% to 7%, and with sensitivity sufficient to detect a signal in a nerve with fewer than 1% of the axons intact. There was no evidence of nerve injury in any animal over the course of 350 stimulus needle penetrations. By use of neuromuscular blockade to identify those muscles generating the surface response, the thyroarytenoid muscle was found to be the primary contributor, whereas the posterior cricoarytenoid muscle was uninvolved.ConclusionsThis evoked electromyographic technique could provide quantitative information regarding the extent of muscle innervation during denervation and regeneration in case of laryngeal paralysis.