Electrophysiology monitoring system and method for predicting cerebral aneurysm postoperative muscle strength index

Abstract

The invention relates to the field of cerebral aneurysm, in particular to an electrophysiology monitoring system and method for predicting cerebral aneurysm postoperative muscle strength indexes, the electrophysiology monitoring system comprises WR and PR, the WR and PR are calculated according to time T1, time T2 and time T3, WR = (T2 / T1) * 100%, PR = [T3 / (T1 + T2)] * 100%; when PR is greater than or equal to 100%, the delay flag is recovered; and when WR is greater than or equal to 100%, short-term muscle strength decrease prediction is represented. The time T1, the time T2 and the time T3 are recorded and are used for calculating WR and PR indexes, so that the postoperative recovery condition of a patient is predicted, a postoperative recovery scheme is quickly formulated, the waiting time is saved, and a personalized recovery scheme can be formulated according to actual indexes.

Description

TECHNICAL FIELD

[0001] The present application relates to the technical field of cerebral aneurysm, in particular to an electrophysiological monitoring system and method for predicting postoperative muscle strength indicators of cerebral aneurysm. BACKGROUND

[0002] Intracranial aneurysm is a common vascular disease in neurosurgery, and its incidence ranks third in hemorrhagic stroke. About 80% of spontaneous subarachnoid hemorrhage is related to intracranial aneurysm. Treatment methods include craniotomy clipping, endovascular repair technology and aneurysm embolization, etc. Among them, aneurysm clipping has the advantages of direct observation and operation control, and is suitable for various types and forms of intracranial aneurysms, including large or complex aneurysms and deep or special anatomic structure aneurysms. The operation can reduce the risk of recurrence and rupture by directly clipping the aneurysm, and the recurrence rate is about 3%.

[0003] Through transcranial electrical stimulation motor evoked potential monitoring (TES-MEP), intraoperative nerve function monitoring can evaluate the brain and spinal cord function status in real time, and reduce the risk of ischemia and functional deficit during and after operation.

[0004] The traditional transcranial electrical stimulation motor evoked potential monitoring only relies on postoperative clinical muscle strength evaluation to determine the treatment plan, which not only has a long waiting time and misses the golden period of treatment, but also makes the rehabilitation plan homogeneous, resulting in excessive intervention for low-risk patients and insufficient rehabilitation for high-risk patients. Therefore, an electrophysiological monitoring system and method for predicting postoperative muscle strength indicators of cerebral aneurysm are urgently needed. SUMMARY

[0005] The purpose of the present application is to solve the problems existing in the prior art, and an electrophysiological monitoring system and method for predicting postoperative muscle strength indicators of cerebral aneurysm are provided.

[0006] In order to achieve the above-mentioned purpose, the present application adopts the following technical solutions: The electrophysiological monitoring system for predicting postoperative muscle strength indicators of cerebral aneurysm comprises a WR and a PR, and the WR and the PR are calculated according to a time T1, a time T2 and a time T3, WR=(T2 / T1)×100%, and PR=[T3 / (T1+T2)]×100%; When the PR is greater than or equal to 100%, it represents a recovery delay marker; When the WR is greater than or equal to 100%, it represents a short-term muscle strength decline prediction.

[0007] The electrophysiological monitoring method for predicting postoperative muscle strength indicators of cerebral aneurysm comprises the following steps: S1: first start temporary vascular occlusion, and simultaneously start a timer to start T1 timing; S2: start real-time monitoring of MEP amplitude, and observe the monitoring results; S3: If MEP amplitude drop < 50% baseline, at this time can continue to block, and continue to monitor; if MEP amplitude continues ≥ 10 seconds and drops ≥ 50% baseline, go to step S4; S4: Trigger sound light alarm to automatically trigger, and at this time record time T1 synchronously, and start T2 timing synchronously; S5: Prepare to remove the vessel clamp in time and remove the blockage; S6: Immediately record time T2 after removing the blockage, and start T3 timing synchronously; S7: Continue to monitor the MEP recovery state, and start stable timing when MEP amplitude fluctuation < 5% baseline; S8: After the stable timing is completed, the situation is stable, and time T3 is recorded immediately; S9: Calculate WR and PR indexes through time T1, time T2 and time T3, and handle the postoperative situation according to the indexes.

[0008] Preferably, the MEP amplitude monitoring interval time in step S2 is 10s.

[0009] Preferably, the corresponding time of removing the vessel clamp and removing the blockage in step S5 is < 15s.

[0010] Preferably, when T2 ≤ T1, wr ≤ 1, at this time the muscle strength of the patient is normal.

[0011] Preferably, the MEP amplitude monitoring interval time in step S7 is 5s, and the stable timing time is 60s.

[0012] Preferably, when no abnormal sign is calculated in step S9, it belongs to low risk, and routine nursing is performed.

[0013] Preferably, when MEP abnormality or single WR / PR ≥ 100% is calculated in step S9, it belongs to medium risk, and intensive intervention is performed.

[0014] Preferably, when WR and PR ≥ 100% or three joint positive are calculated in S9, it belongs to high risk, and intensive care is performed.

[0015] The beneficial effects of the present application are: through recording time T1, time T2 and time T3, and using them to calculate WR and PR indexes, the postoperative recovery situation of the patient is predicted, and then a postoperative recovery scheme is quickly formulated, not only the waiting time is saved, but also the individualized recovery scheme can be formulated according to the actual indexes. BRIEF DESCRIPTION OF DRAWINGS

[0016] Figure 1 The structural block diagram of the electrophysiological monitoring method for predicting postoperative muscle strength indexes of cerebral aneurysm of the present application; Figure 2 To Figure 1 the structure block diagram of postoperative risk analysis in DETAILED DESCRIPTION

[0017] The technical solutions in the embodiments of the present application will be clearly and completely described below with reference to the drawings in the embodiments of the present application. Obviously, the described embodiments are only part of the embodiments of the present application, rather than all the embodiments of the present application.

[0018] Referring to Figures 1-2 , the electrophysiological monitoring system for predicting postoperative muscle strength indicators of cerebral aneurysm, including WR and PR, WR and PR are calculated according to time T1, time T2 and time T3, WR=(T2 / T1)×100%, PR=[T3 / (T1+T2)]×100%; When PR≥100%, it represents a recovery delay sign. When WR≥100%, it represents a short-term muscle strength decline prediction.

[0019] The electrophysiological monitoring method for predicting postoperative muscle strength indicators of cerebral aneurysm, characterized in that it comprises the following steps: S1: first start temporary vascular blockage, and simultaneously start a timer to start T1 timing; S2: start real-time monitoring of MEP amplitude, and observe the monitoring results; S3: if the MEP amplitude decreases by less than 50% of the baseline, the blockage can be continued at this time, and the monitoring is continued; if the MEP amplitude continues for ≥10 seconds and decreases by ≥50% of the baseline, step S4 is entered; S4: trigger an acoustic-optical alarm, and at this time, record time T1 synchronously, and start T2 timing synchronously; S5: prepare to remove the vascular clamp in time and release the blockage; S6: immediately record time T2 after the blockage is released, and start T3 timing synchronously; S7: continuously monitor the MEP recovery state, and start stable timing when the MEP amplitude fluctuates by less than 5% of the baseline; S8: when the stable timing is completed, the situation is stable, and time T3 is immediately recorded; S9: calculate WR and PR indicators through time T1, time T2 and time T3, and predict postoperative situation processing according to the indicators.

[0020] In step S2, the MEP amplitude monitoring interval time is 10s. False negatives are avoided by standardizing the stimulation parameters, and the sensitivity and operation burden can be balanced by the 10s interval.

[0021] Wherein, the corresponding time of removing the blood vessel clamp and unblocking in step S5 is < 15s. The 15s time limit prevents decision delay to ensure smooth operation by eliminating communication ambiguity through standardized password.

[0022] Wherein, when T2≤T1, wr≤1, at this time the patient's muscle strength is normal.

[0023] Wherein, the MEP amplitude monitoring interval time in step S7 is 5s, and the stable timing time is 60s. By high-frequency sampling to capture subtle recovery changes, through 60s stable period, false recovery can be excluded to ensure complete recovery.

[0024] Wherein, when no abnormal flag is calculated in step S9, it belongs to low risk, and routine nursing is performed. At this time, only 6h / 12h / 24h muscle strength evaluation is needed to avoid excessive medical treatment.

[0025] Wherein, when MEP abnormality or single WR / PR≥100% is calculated in step S9, it belongs to medium risk, and intensive intervention is performed. At this time, q2h muscle strength evaluation is needed to seize the golden time window for treatment.

[0026] Wherein, when WR and PR≥100% or three joint positive are calculated in S9, it belongs to high risk, and intensive care is performed. At this time, ICU monitoring, q1h muscle strength evaluation, 24h hyperbaric oxygen treatment and individualized rehabilitation plan are needed to prevent complications.

[0027] In this scheme, WR and PR are quantitatively calculated during operation to predict postoperative muscle strength outcome.

[0028] Wherein, WR≥100% can predict the risk of short-term muscle strength decline (AUC=0.884), reflecting the response delay of the operator from early warning to unblocking (T2>T1).

[0029] PR≥100% indicates delayed nerve recovery (AUC=0.809), indicating increased difficulty of rehabilitation.

[0030] And according to the WR and PR indexes to predict the risk after operation.

[0031] When no abnormal flag is calculated, it belongs to low risk, at this time only routine 6h / 12h / 24h muscle strength evaluation is needed to avoid excessive medical treatment.

[0032] When MEP abnormality or single WR / PR≥100%, it belongs to medium risk, at this time q2h muscle strength dynamic evaluation and neuroprotective agent treatment are started to save time and intervene within 24 hours of the golden intervention window after operation.

[0033] When WR and PR are both greater than 100% or all of them are positive, it is high risk, at this time, q1h muscle strength monitoring under ICU monitoring, 24 hours of hyperbaric oxygen therapy and individualized rehabilitation program, direct nerve repair to ischemic penumbra.

[0034] The grading scheme makes resources flow to high-risk groups and avoids over-treatment of low-risk groups.

[0035] Therefore, when T2≤T1, wr≤1, at this time the patient's muscle strength is normal. Therefore, by controlling the time of T2, it can be ≤T1, so that the patient's muscle strength is normal. Because of individual differences, T1 of each surgical patient is uncertain, but the time of T1 is obtained during surgery, at this time only artificial control of T2 is needed.

[0036] T1 and T2 are fixed, but T2 is artificially controllable, when T2 is equal to T1, it will trigger an alarm again, which is a prompt for the operator to remove the blockage, if the blockage is not removed, it may affect the change of the patient's muscle strength.

[0037] In the present application, by recording the time T1, the time T2 and the time T3, and using them to calculate the WR and PR indexes, the postoperative recovery of the patient is predicted, and then a postoperative recovery plan is quickly formulated, not only saving the waiting time, but also formulating a personalized recovery plan according to the actual index.

[0038] The above is only the preferred specific embodiment of the present application, but the protection scope of the present application is not limited to this, any person skilled in the art in the technical range disclosed by the present application, according to the technical scheme and the inventive concept of the present application, equivalent replacement or change, should be covered in the protection scope of the present application.

Claims

1. An electrophysiological monitoring system for predicting postoperative muscle strength indicators for brain aneurysms, characterized in that, The WR and PR are calculated according to time T1, time T2 and time T3, WR=(T2 / T1)×100%, PR=[T3 / (T1+T2)]×100%; When the PR≥100%, it represents a recovery delay flag; When the WR≥100%, it represents a short-term muscle strength decline prediction.

2. The method of electrophysiological monitoring of predictive indicators of muscle strength after cerebral aneurysm surgery according to claim 1, characterized in that, The method comprises the following steps: S1: first start temporary blood vessel blocking, and simultaneously start a timer to start T1 timing; S2: start real-time monitoring of MEP amplitude, and observe the monitoring result; S3: if the MEP amplitude decreases by less than 50% of the baseline, the blocking can be continued, and the monitoring is continued; if the MEP amplitude continues for more than 10 seconds and decreases by more than 50% of the baseline, step S4 is entered; S4: trigger an audible and light alarm, and at this time, time T1 is recorded, and T2 timing is started; S5: prepare to remove the blood vessel clamp and release the blocking in time; S6: immediately record time T2 after the blocking is released, and start T3 timing; S7: continuously monitor the MEP recovery state, and when the MEP amplitude fluctuation is less than 5% of the baseline, start stable timing; S8: when the stable timing is completed, the situation is stable, and time T3 is immediately recorded; S9: calculate the WR and PR indexes through time T1, time T2 and time T3, and predict the postoperative situation according to the indexes.

3. The method of electrophysiological monitoring to predict postoperative muscle strength indicators of brain aneurysms according to claim 2, characterized in that, The MEP amplitude monitoring interval time in step S2 is 10s.

4. The method of electrophysiological monitoring to predict postoperative muscle strength indicators of brain aneurysms according to claim 2, characterized in that, The corresponding time of removing the blood vessel clamp and releasing the blocking in step S5 is less than 15s.

5. The method of electrophysiological monitoring of predictive indicators of muscle strength after cerebral aneurysm surgery according to claim 2, characterized in that, When T2≤T1, wr≤1, the muscle strength of the patient is normal.

6. The method of electrophysiological monitoring of predictive indicators of muscle strength after cerebral aneurysm surgery according to claim 2, characterized in that, The MEP amplitude monitoring interval time in step S7 is 5s, and the stable timing time is 60s.

7. The method of electrophysiological monitoring of predictive indicators of muscle strength after cerebral aneurysm surgery according to claim 2, characterized in that, When no abnormal flag is calculated in step S9, it belongs to low risk, and routine nursing is performed.

8. The method of electrophysiological monitoring of predictive indicators of muscle strength after cerebral aneurysm surgery according to claim 2, characterized in that, When MEP abnormality or single WR / PR≥100% is calculated in step S9, it belongs to medium risk, and intensive intervention is performed.

9. The method of electrophysiological monitoring of predictive indicators of muscle strength after cerebral aneurysm surgery according to claim 2, characterized in that, When WR and PR≥100% or three joint positive are calculated in S9, it belongs to high risk, and intensive care is performed.

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