猪手术模型对甲状腺手术的手术内神经监测

Summary

本研究旨在建立猪模型甲状腺手术过程中神经监测的标准方案。在这里, 我们提出了一个方案, 以证明全身麻醉, 比较不同类型的电极, 并探讨电生理特征的正常和受伤的喉返神经。

Abstract

术中喉返神经 (rln) 会导致声带麻痹, 从而干扰言语, 并有可能干扰呼吸。近年来, 术中神经监测 (ionm) 已被广泛应用于一种辅助技术, 用于定位 rln、检测 rln 损伤和预测手术中的声带功能。许多研究还利用动物模型研究 ionm 技术的新应用, 并制定可靠的策略, 以防止术中 rln 损伤。本文的目的是介绍一种在 ionm 研究中使用猪模型的标准协议。本文介绍了诱导全身麻醉、进行气管插管的方法和实验设计, 探讨了 rln 损伤的电生理特征。该协议的应用可以提高在猪 ionm 研究中实施3r 原理 (替换、还原和细化) 的总体效果。

Introduction

虽然甲状腺切除术现在是世界范围内常见的手术, 术后语音功能障碍仍然是常见的。术中喉返神经 (rln) 会导致声带麻痹, 从而干扰言语, 并有可能干扰呼吸。此外, 喉上神经的外支的损伤可以通过影响音高和声带投射引起重大的声音变化。

甲状腺手术中的术中神经监测 (ionm) 作为一种辅助技术, 用于绘制和确认 rln、迷走神经 (vn) 和喉上神经 (ebsln) 的外支。由于 ionm 可用于证实和阐明 rln 损伤的机制, 并可用于检测 rln 的解剖变异, 可用于预测甲状腺切除术后声带功能。因此, ionm 在甲状腺手术中增加了一种新的功能动态, 并为外科医生提供仅通过直接可视化 1^、2、3^、4、5无法获得的信息。^{,6,7.,8,9,10个}。

最近, 许多前瞻性研究利用猪模型优化了 ionm 技术的使用, 并建立了预防术中 rln 损伤^{11、12、13、14的}可靠策略. ^{, 15,16,17,18,19,20}。猪模型也被用来为从业者提供重要的教育和培训, 在临床应用的 ionm。

因此, 动物模型与 ionm 技术的结合是研究 rln 损伤21病理生理学^的一个有价值的工具。本文的目的是证明猪模型在 ionm 研究中的应用。具体介绍了如何诱导全身麻醉, 进行气管插管, 并建立了研究各种 rln 损伤类型的电生理特征的实验。

Protocol

动物实验获得台湾高雄医科大学动物护理和使用机构委员会 (iacuc) 批准 (议定书号: iacca-102046, 102046, 102046)。 1. 动物准备和麻醉 猪动物模型注: 本研究应用文献中描述的协议, 建立了 ion11、12、13、14、15、16、 <s…

Representative Results

电生理研究基线 emg 数据、最小最大刺激水平和刺激响应曲线使用标准单极刺激探针, vn 和 rln 刺激得到的最小刺激水平分别为0.1 至 0.3 ma。一般来说, 刺激电流与产生的 emg 振幅 11,17呈正相关。emg 振幅以最大刺激水平为 0.7 ma, 用于 vn 刺激, 0.5 ma 为 rln刺激 11。 <p class="jove_content" fo:keep-together.within-p…

Discussion

rln 和 ebsln 的损伤仍然是甲状腺手术引起的重要发病原因。直到最近, 神经损伤只能通过直接显示创伤来识别。使用 ionm 现在可以通过施加刺激和记录目标肌肉的收缩来进一步的 rln 功能识别。然而, 目前, 传统的间歇性和连续的 ionm 系统在假阳性和假阴性解释方面都有一些技术局限性。因此, 适当的动物模型是必要的这些临床问题。

最近, 大量的动物实验研究试图克服 ionm 的陷…

Materials

Criticare systems	nGenuity	8100E	physiologic monitoring, including capnography, electrocardiography (ECG) and monitoring of oxygenation (SaO2)
Intraoperative NIM nerve monitoring systems	Medtronic	NIM-Response 3.0	monitor EMG activity from multiple muscles. If there is a change in nerve function, the NIM system may provide audible and visual warnings to help reduce the risk of nerve damage.
NIM TriVantage EMG Tube	Medtronic	8229706	6 mm ID, 8.2 mm OD. The NIM TriVantage EMG Tube is a standard size, non-reinforced, DEHP-free PVC tube that features smooth, conductive silver ink electrodes and a cross-band to guide placement. It has reduced sensitivity to rotation and movement while offering increased EMG responses that facilitate improved nerve dissection.
NIM Contact Reinforced EMG Endotracheal Tube	Medtronic	8229506	6 mm ID, 9 mm OD. The NIM Contact EMG Tube continuously monitors electromyography (EMG) activity during surgery. An innovative design allows the tube to maintain contact, even upon rotation. Vocal cords are more easily visible against the white band. Recording electrode leads are twisted pair. Packaged sterile with one green and one white subdermal needle. Single use.
NIM Standard Reinforced EMG Endotracheal Tube	Medtronic	8229306	6 mm ID, 8.8 mm OD. The NIM Standard EMG Tube continuously monitors electromyography (EMG) activity during surgery. Recording electrode leads are twisted pair. Packaged sterile with one green and one white subdermal needle. Single use.
NIM Flex EMG Endotracheal Tube	Medtronic	8229960	6 mm. The NIM Flex EMG Tube monitors vocal cord and recurrent laryngeal nerve EMG activity during surgery. An updated, dual-channel design allows the tube to maintain contact with the vocal cords, even upon rotation. Recording electrode leads are twisted pair. Packaged sterile with one green and one white subdermal needle. Single use.
Standard Prass Flush-Tip Monopolar Stimulator Probe	Medtronic	8225101	Tips and Handles. For locating and mapping cranial nerves in the surgical field, the single-use Standard Prass Monopolar Stimulating Probe features a flush 0.5 mm tip diameter. The probe is insulated to the tip to prevent current shunting. Individually sterile packaged.
Ball-Tip Monopolar Stimulator Probe	Medtronic	8225275/ 8225276	Tip and Handle, 1.0 mm/ 2.3mm. Featuring a flexible ball tip and flexible shaft, the single-use Ball-Tip Monopolar Stimulating Probe allows greater access to neural structures. The 1.0 mm tip diameter allows atraumatic contact to larger neural structures. The probe is insulated to the tip to prevent current shunting. Individually sterile packaged.
Yingling Flex Tip Monopolar Stimulator Probe	Medtronic	8225251	Tips and Handles. The highly flexible single-use Yingling Monopolar Stimulating Probe allows stimulation in areas outside the surgeon’s field of view. The platinum-iridium wire of the probe is fully insulated to the ball tip to prevent current shunting. Individually sterile packaged with one green subdermal electrode.
Prass Bipolar Stimulator Probe	Medtronic	8225451	The single-use Prass Bipolar Stimulating Probe features a slim, flexible tip that allows greater access to neural structures. The probe tip is 0.5 mm in distance between cathode and anode for minimal shunting. Individually sterile packaged.
Concentric Bipolar Stimulator Probe	Medtronic	8225351	The single-use Concentric Bipolar Stimulating Probe features a 360° contact area. Insulation is complete to the active tip; cables and handles are polarized. Individually sterile packaged.
Side-by-Side Bipolar Stimulator Probe	Medtronic	8225401	The single-use Side-by-Side Bipolar Stimulating Probe features probe tips that are 1.3 mm apart, allowing neural structures to be stimulated between the tips. Insulation is complete to the active tip; cables and handles are polarized. Individually sterile packaged.
APS (Automatic Periodic Stimulation) Electrode*	Medtronic	8228052 / 8228053	2 mm/ 3mm. The APS Electrode offers continuous, real-time monitoring. The electrode is placed on the nerve and can provide early warning of a change in nerve function.
Neotrode ECG Electrodes	ConMed	1741C-003	The electrode is made of a clear tape material, which allows for continuous observation of the patient's skin during monitoring.
LigaSure Small Jaw	Medtronic	LF1212	A FDA-approved electrothermal bipolar vessel sealing system for surgery