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SAH 환자에서 수술중 운동유발전위와 출혈의 중증도와의 연관성
The association between motor evoked potentials during surgery and the severity of the hemorrhage in patients with subarachnoid hemorrhage
김동준 , 임성혁 , 박찬우 , 박진우 , 박상구 , 한형태
UCI I410-ECN-0102-2017-510-000095952
이 자료는 4페이지 이하의 자료입니다.
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배경(Background) : To measure motor evoked potentials(MEP) during emergency surgery is often difficult in patients with subarachnoid hemorrhage(SAH) from a ruptured cerebral aneurysm, The cause of these difficulties may be considered as damage to the motor pathway by hemorrhage. To identify the cause of difficulties in measuring MEP, we defined the association between motor evoked potentials during surgery and the severity of the hemorrhage in patients with subarachnoid hemorrhage. 방법(Methods): From January 2010 to June 2014, we analyzed the initial CT and intraoperative MEP finding of 95 patients, who were admitted to Samsung Seoul hospital due to SAH from a ruptured cerebral aneurysm and had emergency operation on admission date. The severity of SAH was classified using the Fisher grade. The anesthesia was induced with total intravenous anesthesia(TIVA), and the use of muscle relaxant was avoided after induction of anesthesia. For stimulation and recording MEP, subdermal needle electrodes were used. The recording electrode were placed on abductor pollicis brevis(APB) and abductor digiti minimi(ADM) muscle in upper extremity and on tibialis anterior(TA) and abductor hallucis brevis(AHB) in lower extremity. 결과(Results): All 74 people since the beginning of the MEP wave formation is not surgery or left and right showed a significant difference when 13 people, but the significant difference is the wave of the form (5), unilateral phase annaon but if five people, but the upper extremity or if annaon 2 adults 1 patient each. Gr 4 of which more than eight out of 13 Fisher gr 4 suggest that this was more than the formation of the MEP waveform can not be carried out smoothly, it can be seen that the point is to set a baseline MEP hemorrhage after removal of the dura open to any should be made about the timing of. 고찰(Discussion): In fact, tests performed in the operating room during surgery intensive monitoring only one portion of the MEP waveforms were not observed and not one of SAH emergency surgery when considering characteristics may be quite embarrassing if the preoperative condition of the patient, such as Fisher grade carefully Check that the setting of Baseline MEP is somewhat removed from hemorrhage at the time should be set at the time of the change of the waveform during surgery surgeon to accurately observe and can give an appropriate warning sign..

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