Clinical feasibility and safety of transoesophageal motor-evoked potential monitoring
Clinical feasibility and safety of transoesophageal motor-evoked potential monitoring
复制标题
DOI：
10.1093/ejcts/ezaa002
复制
发表时间：
2020-06-01
影响因子：
3.4
通讯作者：
Ohashi, Yuko
中科院分区：
文献类型：
--
作者：
Shiiya, Norihiko;Tsuda, Kazumasa;Ohashi, Yuko
目的：犬实验表明经食管运动诱发电位监测是可行、安全、稳定的，对缺血的反应比经颅运动诱发电位更快，具有更好的预后价值。我们的目的是阐明这些发现是否具有临床可重复性。方法：采用安装在大直径硅管上的双相食管电极和5组双相波刺激进行经食管刺激。结果对18例患者（中位年龄74.5岁，男性13例）进行分析。结果：无死亡、脊髓损伤或经食管刺激相关并发症。3例患者经颅运动诱发电位由于不明原因未能监测到手术结束，其中2例从手术开始。2例经食管超声探头操作后，经食管运动诱发电位不可唤起。经食管刺激时上肢剧烈运动3例。在手术结束前成功完成两种监测方法的14例患者中（11例胸腹修复，3例降主动脉修复），经颅刺激6例，经食管刺激1例，最终结果判断为假阳性。经食管刺激能显著降低刺激强度，显著提高上肢振幅，而下肢振幅与之相当。结论：经食管运动诱发电位监测在临床上可行、安全，假阳性率低。需要更好的电极设计，以避免经食管回声操纵其迁移。可能需要进一步的研究。临床注册号：UMIN000022320。
OBJECTIVES: Canine experiments have shown that transoesophageal motor-evoked potential monitoring is feasible, safe and stable, with a quicker response to ischaemia and a better prognostic value than transcranial motor-evoked potentials. We aimed to elucidate whether or not these findings were clinically reproducible.METHODS: A bipolar oesophageal electrode mounted on a large-diameter silicon tube and a train of 5 biphasic wave stimuli were used for transoesophageal stimulation. Results of 18 patients (median age 74.5years, 13 males) were analysed.RESULTS: There were no mortalities, spinal cord injuries or complications related with transoesophageal stimulation. Transcranial motor-evoked potential could not be monitored up to the end of surgery in 3 patients for unknown reasons, 2 of whom from the beginning. Transoesophageal motor-evoked potential became non-evocable after manipulation of a transoesophageal echo probe in 2 patients. Strenuous movement of the upper limbs during transoesophageal stimulation was observed in 3 patients. In 14 patients who successfully completed both monitoring methods up to the end of surgery (11 thoraco-abdominal and 3 descending aortic repair), the final results were judged as false positives in 6 by transcranial stimulation and in 1 by transoesophageal stimulation. The stimulation intensity was significantly lower and the upper limb amplitude was significantly higher by transoesophageal stimulation, while the lower limb amplitude was comparable.CONCLUSIONS: Transoesophageal motor-evoked potential monitoring is clinically feasible and safe with a low false positive rate. A better electrode design is required to avoid its migration by transoesophageal echo manipulation. Further studies may be warranted.Clinical registration number: UMIN000022320.