在甲狀腺手術中神經監測系統採用間斷性的高電流刺激神經的安全：一個以豬為模型的安全性研究
Safety of High-Current Stimulation for Intermittent Intraoperative Neural Monitoring in Thyroid Surgery: A Porcine Model

專家評論：

Objectives: During monitored thyroidectomy, displacement of the recurrent laryngeal nerve (RLN) or vagus nerve (VN) in some complicated cases can increase the risk of injury. Although increasing the stimulus current can facilitate nerve mapping and localization, the safety of a high-current stimulus remains unknown. Therefore, this study evaluated the safety of a

high-current stimulus in a porcine model.

Methods: Short-duration (1 minute), high-current (3, 5, 10, 15, 20, 25, and 30 mA at 4Hz) stimulus pulses were repeatedly applied to the RLN or VN in six anesthetized piglets. The safety of the high-current stimulus pulses was assessed in terms of hemodynamic stability during VN stimulation and in terms of nerve function integrity after VN and RLN stimulation.

Results: During VN stimulation with a high-current stimulus pulse, sinus rhythms in all six piglets showed stable heartrates, and mean arterial pressure was unaffected. High-current stimulation of the VN and the RLN did not affect electromyography amplitude or latency.

Conclusion: This porcine study showed that applying a short-duration, high-current stimulus pulse to the VN or RLN during monitored thyroidectomy has no harmful effects. In clinical practice, a short duration of high-current stimulus can be applied to facilitate neural mapping, especially in patients with disoriented nerve positions.