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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2024, Vol. 14 ›› Issue (02) : 65 -72. doi: 10.3877/cma.j.issn.2095-123X.2024.02.001

专家共识

颅内外血管搭桥术中神经电生理监测中国专家共识（2024版）
中国医师协会神经外科医师分会神经电生理监测学组, 中国研究型医院学会临床神经电生理专业委员会   
  • 收稿日期:2023-12-12 出版日期:2024-04-15

Chinese expert consensus on neurophysiologic monitoring during extracranial-intracranial bypass surgery (2024 edition)

Neurophysiological Monitoring Group of the Chinese Medical Doctor Association Neurosurgery Branch, Clinical Neurophysiology Committee of the Chinese Research Hospital Association   

  • Received:2023-12-12 Published:2024-04-15
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中国医师协会神经外科医师分会神经电生理监测学组, 中国研究型医院学会临床神经电生理专业委员会. 颅内外血管搭桥术中神经电生理监测中国专家共识（2024版）[J]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 65-72.

Neurophysiological Monitoring Group of the Chinese Medical Doctor Association Neurosurgery Branch, Clinical Neurophysiology Committee of the Chinese Research Hospital Association. Chinese expert consensus on neurophysiologic monitoring during extracranial-intracranial bypass surgery (2024 edition)[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(02): 65-72.

颅内外血管搭桥手术是神经外科常用技术，但手术操作可引起血流灌注异常，进而导致术后新发脑缺血与神经功能障碍等并发症，严重影响患者预后。术中神经电生理监测（IONM）能有效识别早期术中缺血，减少手术并发症，还能评估搭桥完成后脑血流灌注的改善情况。目前国内外尚未制定相关规范或共识。本团队在回顾国内外临床证据的基础上，经过德尔菲专家咨询，制定此专家共识，内容包括颅内外血管搭桥手术IONM的意义、颅内外血管搭桥手术中IONM的方法、颅内外血管搭桥手术IONM的适应证及禁忌证、不同疾病的搭桥手术IONM监测策略和结果判读、其他注意事项，并根据GRADE证据等级标准，给出了8条相应的推荐意见，以期为颅内外血管搭桥手术IONM的临床实践提供参考。

关键词: 颅内外血管搭桥手术, 缺血性脑血管病, 术中神经电生理监测, 复杂动脉瘤, 专家共识

Extracranial-intracranial (EC-IC) bypass surgery is a commonly used technique in neurosurgery, but abnormal perfusion caused by surgical operation can lead to postoperative complications such as new-onset cerebral ischemia and neurological dysfunction, which seriously affects the prognosis of patients. Intraoperative neurophysiological monitoring (IONM) can effectively identify early intraoperative ischemia, reduce surgical complications, and assess the improvement of cerebral perfusion after the establishment of EC-IC bypass. However, no relevant norms or consensus have been developed around the world. Based on the review of reported clinical evidence, our team developed this expert consensus after Delphi expert consultation, forming a consensus on 5 aspects: the significance of IONM for EC-IC bypass surgery, the method of IONM for EC-IC bypass surgery, indications and contraindications for IONM for EC-IC bypass surgery, the monitoring strategy and interpretation of IONM results for EC-IC bypass surgery in different diseases, and other notes. Based on the GRADE evidence level standard, this expert consensus combines the national expert opinions on neurophysiology and EC-IC bypass to give eight comments on the clinical practice of IONM for EC-IC bypass surgery.

Key words: Extracranial-intracranial bypass surgery, Ischaemic cerebrovascular disease, Intraoperative neurophysiological monitoring, Complex aneurysms, Expert consensus
表1 证据质量与推荐强度分级
Tab.1 Grading the quality of evidence and strength of recommendation
分级 具体描述
证据质量等级  
高（A） 对观察值非常有把握：观察值接近真实值
中（B） 对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低（C） 对观察值的把握有限：观察值可能与真实值有很大差别
极低（D） 对观察值几乎没有把握：观察值与真实值可能有极大差别
推荐强度分级  
强（1） 明确显示干预措施利大于弊或弊大于利
弱（2） 利弊不确定或无论质量高低的证据均显示利弊相当
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