副甲状腺切除术中电肌图 (EMG) 的陷:未被识别的伪胆酶缺乏症的病例报告
Mario Villasenor1, Tobias de la Garza Eckle1, Matthew Lyman1
1Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
患有伪胆酶 (PChE) 缺乏症的患者在甲状腺外科手术期间可能表现出异常的电肌图 (EMG) 信号. 这一案例凸显了诊断方面的挑战以及需要麻醉检查清单来确保患者的安全.
科学领域:
- 麻醉学 麻醉学
- 神经肌肉监测 神经肌肉监测
- 生物化学 生物化学
背景情况:
- 已知 Pseudocholinesterase (PChE) 缺陷会影响手术期间的神经肌肉监测.
- 患有PChE缺乏症的患者可能会表现出改变的电肌图 (EMG) 信号.
- 异常EMG信号的持续时间和PChE缺乏的相关监测挑战没有得到充分的记录.
研究的目的:
- 报告患有未诊断的PChE缺乏症的患者进行副甲状腺切除术的诊断挑战.
- 突出PChE缺乏对手术内神经监测的影响.
- 为了强调对标准化麻醉方案的需要.
主要方法:
- 一个案例报告,一名74岁的女性接受了选择性甲状腺切除术,并进行了手术内神经监测.
- 使用普罗波福,芬太尼和顺胆来诱导麻醉.
- 监测EMG和随后的PChE水平评估.
主要成果:
- 患者在出现时表现出严重的软弱,尽管最初的EMG反应.
- 四列列车比率 (TOFR) 为0.8,后潜能减弱,表明残留的神经肌肉阻塞.
- 随访PChE水平证实了同卵性PChE缺乏 (952 U/L).
结论:
- 如果EMG信号在早期缺失或随着时间的推移而增加,就有理由怀疑PChE缺乏.
- 在甲状腺外科手术中缺乏EMG监测的全面检查清单.
- 推基于证据的麻醉检查清单,以减轻与虚假阴性EMG结果相关的安全和经济风险.
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