术中刺激阴部神经时影响肛门括约肌收缩的因素

Amador C Lagunas, Po-Ju Chen, Luis Ruiz, Amolak S Jhand, Nystha Baishya, Scott F Lempka, Priyanka Gupta, Tim M Bruns
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引用次数: 0

摘要

导言:在临床阴部神经调控中,影响肛门外括约肌(EAS)募集的因素尚不十分清楚。因此,本研究的目的是确定并量化对接受阴部神经调控治疗下尿路症状的参与者的肛门外括约肌募集有显著影响的生理、人口统计学和刺激因素:方法: 在参与者进入研究时收集其人口统计学和诊断信息。采用核磁共振成像(MRI)和计算机断层扫描(CT)捕捉患者的阴部神经解剖结构,并记录植入导线的位置。在手术室植入神经刺激器导线时,记录了不同振幅和脉宽的阴部神经刺激对 EAS 的激活情况。研究人员使用线性混合模型来量化每个变量对 16 名入选者 EAS 招募的影响:结果:参与者的性别、年龄和体重指数对阴部神经刺激的 EAS 招募没有显著影响。参与者的诊断与 EAS 招募有显著关系,这可能是由于不平衡的小组规模造成的。脉冲宽度为 210 μs 激活阈值 EAS 所需的电流明显少于 60 μs (p = 0.005),激活阈值 EAS 所需的电荷明显少于 450 μs (p = 0.02)。刺激电极与阴部神经之间的距离增加会降低 EAS 反应的幅度(p = 0.0011)并提高 EAS 激活阈值(p < 0.001):结论:在测试的三种脉冲宽度中,210 μs 所需的电荷最少,是刺激的良好选择。电极与阴部神经之间的距离在 EAS 和阴部神经募集中起着重要作用,因此在导联植入过程中应优先考虑最小化这一距离。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors affecting anal sphincter recruitment during intraoperative pudendal nerve stimulation
Introduction: The factors that impact external anal sphincter (EAS) recruitment in clinical pudendal neuromodulation are not well understood. Therefore, the goal of this study was to identify and quantify physiological, demographic, and stimulation factors that significantly affect EAS recruitment in participants receiving pudendal neuromodulation for treatment of lower urinary tract symptoms. Methods: Demographic and diagnostic information were collected from participants upon entry to the study. MRI and CT were used to capture patient pudendal nerve anatomy and register the location of the implanted lead. EAS activation by pudendal nerve stimulation at different amplitudes and pulse widths was recorded during neurostimulator lead implantation in the operating room. Linear mixed modeling was used to quantify the impact each variable had on EAS recruitment in the sixteen enrolled participants. Results: Participant sex, age, and BMI did not significantly affect EAS recruitment with pudendal nerve stimulation. Participant diagnoses had significant relationships to EAS recruitment, likely due to unbalanced group sizes. A pulse width of 210 μs required significantly less current than 60 μs (p = 0.005) to activate the EAS at threshold and significantly less charge than 450 μs (p = 0.02) to activate the EAS at threshold. Increased distance between the stimulating electrode and the pudendal nerve decreased the magnitude of the EAS response (p = 0.0011) and increased EAS activation threshold (p < 0.001). Conclusions: Of the three tested pulse widths, 210 μs requires the least charge and is a good choice for stimulation. The distance between the electrode and pudendal nerve plays an important role in EAS and pudendal nerve recruitment and minimizing this distance should be a priority during lead implantation.
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