CN116019463B - Intraoperative continuous nerve monitoring system and method - Google Patents
Intraoperative continuous nerve monitoring system and method Download PDFInfo
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- CN116019463B CN116019463B CN202211421414.2A CN202211421414A CN116019463B CN 116019463 B CN116019463 B CN 116019463B CN 202211421414 A CN202211421414 A CN 202211421414A CN 116019463 B CN116019463 B CN 116019463B
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- 210000005036 nerve Anatomy 0.000 title claims abstract description 75
- 238000012544 monitoring process Methods 0.000 title claims abstract description 49
- 238000000034 method Methods 0.000 title claims abstract description 18
- 238000012937 correction Methods 0.000 claims abstract description 48
- 238000004364 calculation method Methods 0.000 claims abstract description 20
- 238000013528 artificial neural network Methods 0.000 claims abstract description 10
- 230000000638 stimulation Effects 0.000 claims description 18
- 210000001186 vagus nerve Anatomy 0.000 claims description 10
- 210000002416 recurrent laryngeal nerve Anatomy 0.000 claims description 8
- 230000007383 nerve stimulation Effects 0.000 claims description 7
- 230000001537 neural effect Effects 0.000 claims description 5
- 230000004936 stimulating effect Effects 0.000 claims description 5
- 238000002474 experimental method Methods 0.000 abstract description 4
- 208000005248 Vocal Cord Paralysis Diseases 0.000 abstract description 3
- 230000002980 postoperative effect Effects 0.000 abstract description 3
- 208000028389 Nerve injury Diseases 0.000 description 4
- 230000008901 benefit Effects 0.000 description 4
- 230000008764 nerve damage Effects 0.000 description 4
- 210000001260 vocal cord Anatomy 0.000 description 3
- 206010067484 Adverse reaction Diseases 0.000 description 2
- 206010003671 Atrioventricular Block Diseases 0.000 description 2
- 208000030714 Recurrent Laryngeal Nerve injury Diseases 0.000 description 2
- 230000006838 adverse reaction Effects 0.000 description 2
- 230000000747 cardiac effect Effects 0.000 description 2
- 238000002567 electromyography Methods 0.000 description 2
- 210000003801 laryngeal nerve Anatomy 0.000 description 2
- 210000004072 lung Anatomy 0.000 description 2
- 210000000653 nervous system Anatomy 0.000 description 2
- 210000001685 thyroid gland Anatomy 0.000 description 2
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 230000005856 abnormality Effects 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 230000007547 defect Effects 0.000 description 1
- 239000003814 drug Substances 0.000 description 1
- 230000000004 hemodynamic effect Effects 0.000 description 1
- 238000011534 incubation Methods 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 230000003447 ipsilateral effect Effects 0.000 description 1
- 239000011159 matrix material Substances 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 210000002990 parathyroid gland Anatomy 0.000 description 1
- 230000008569 process Effects 0.000 description 1
- 238000012545 processing Methods 0.000 description 1
- 238000004904 shortening Methods 0.000 description 1
- 238000012360 testing method Methods 0.000 description 1
- 238000012549 training Methods 0.000 description 1
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Abstract
The invention relates to an intraoperative continuous nerve monitoring system, which comprises a display and alarm module, wherein the display and alarm module comprises: the prediction module is used for calculating to obtain predicted electromyogram data by adopting a neural network algorithm according to the historical electromyogram data; the trusted data calculation module is used for calculating trusted electromyogram data according to the original electromyogram data and the predicted electromyogram data; the correction coefficient calculation module is used for calculating and obtaining a correction coefficient according to the original electromyogram data and the trusted electromyogram data; the correction module is used for correcting the original electromyogram data by multiplying the correction coefficient to obtain corrected electromyogram data; and the alarm module is used for alarming according to the preset threshold value and the corrected electromyogram data. The invention also includes a monitoring method. Experiments show that compared with intermittent nerve monitoring, continuous nerve monitoring can effectively reduce the incidence rate of postoperative permanent vocal cord paralysis, and the difference has statistical significance.
Description
Technical Field
The invention relates to an intraoperative continuous nerve monitoring system and a continuous nerve monitoring method.
Background
The clinical intra-operative nervous system monitoring (Intraoperative Neuromonitoring IONM) or intra-operative neurophysiologic monitoring (Intraoperative Neurophysiological Monitoring) is used for expressing and applying various neurophysiologic techniques and hemodynamic monitoring techniques to monitor the integrity of nervous system functions in dangerous states during operation. These monitoring techniques have been applied for many years in developed countries and are gradually perfected to form a complete intra-operative monitoring system. Intraoperative nerve monitoring has now evolved into an important component in modern clinical medicine. Nerve monitoring has become an indispensable and important component in detecting the integrity of nerve functions in clinical operations, reducing nerve damage and improving the quality of the operations.
Taking thyroid operation complications as an example, nerve monitoring is used at present, the technology is used for reducing operation difficulty and shortening operation time, but intermittent nerve monitoring cannot continuously test nerves in operation, and the nerves are possibly damaged in two monitoring times.
For the speech function after thyroid and parathyroid gland operation, it is not enough to only keep the laryngeal return nerve function well, and only under the condition of simultaneously keeping the upper laryngeal nerve, especially the external branches of the upper laryngeal nerve, the voice can be recovered optimally. Therefore, for intra-operative nerve monitoring, particularly continuous nerve monitoring, more precise control is required.
Disclosure of Invention
The invention aims to solve the defects of the prior art, and provides an intraoperative continuous nerve monitoring system, which comprises a nerve stimulation module, a myoelectricity acquisition module and a display and alarm module, wherein the nerve stimulation module is used for stimulating nerves, the myoelectricity acquisition module is used for acquiring nerve myoelectricity data, and the display and alarm module comprises:
the acquisition module acquires the original electromyogram data acquired by the electromyogram acquisition module at the current time;
The prediction module is used for calculating to obtain predicted electromyogram data by adopting a neural network algorithm according to the historical electromyogram data;
The trusted data calculation module is used for calculating trusted electromyogram data according to the original electromyogram data and the predicted electromyogram data;
The correction coefficient calculation module is used for calculating and obtaining a correction coefficient according to the original electromyogram data and the trusted electromyogram data;
the correction module is used for correcting the original electromyogram data by multiplying the correction coefficient to obtain corrected electromyogram data;
The display module displays the original electromyogram data and the corrected electromyogram data;
And the alarm module is used for alarming according to the preset threshold value and the corrected electromyogram data.
The electromyographic data is selected from one or more of amplitude value, latency period and period.
The display and alarm module further comprises a historical data updating decision module, and judges whether the correction coefficient is within a preset threshold range according to the correction coefficient obtained by the correction coefficient calculation module, if so, the historical electromyogram data is not updated, and if not, a group of new historical electromyogram data is replaced.
The myoelectricity acquisition module is used for simultaneously acquiring left and right side nerve myoelectricity, and if the ratio of left and right side nerve myoelectricity data at the current time exceeds a preset threshold value, the nerve myoelectricity data at the previous time is used as nerve myoelectricity data at the current time.
The left and right nerve is left and right vagus nerve or left and right recurrent laryngeal nerve.
The stimulation intensity of the nerve stimulation module is 1-2 mA, and the continuous stimulation frequency is not higher than 30 times/min.
A method of intraoperative continuous nerve monitoring, the method comprising the steps of:
An acquisition step of acquiring original electromyogram data at the current time;
A prediction step, according to the historical electromyogram data, calculating to obtain predicted electromyogram data by adopting a neural network algorithm;
A trusted data calculation step of calculating trusted electromyogram data according to the original electromyogram data and the predicted electromyogram data;
A correction coefficient calculation step of calculating a correction coefficient according to the original electromyogram data and the trusted electromyogram data;
a correction step of multiplying the original electromyogram data by a correction coefficient to correct the original electromyogram data to obtain corrected electromyogram data;
A display step of displaying original electromyogram data and corrected electromyogram data;
And alarming according to the preset threshold value and the corrected electromyogram data.
The electromyographic data is selected from one or more of amplitude value, latency period and period.
The monitoring method further comprises a historical data updating decision step, wherein whether the correction coefficient is within a preset threshold range is judged according to the correction coefficient obtained by the correction coefficient calculation module, if yes, the historical electromyogram data are not updated, and if not, a group of new historical electromyogram data are replaced.
And in the monitoring process, the left and right nerve myoelectricity is collected simultaneously, and if the ratio of the left and right nerve myoelectricity data at the current time exceeds a preset threshold value, the nerve myoelectricity data at the previous time is used as the nerve myoelectricity data at the current time.
The advantage of continuous nerve monitoring is that:
① Monitoring the complete state of the functions of the whole vagus nerve and the ipsilateral recurrent laryngeal nerve in real time in the whole operation process;
② An electromyographic signal map associated with the early nerve injury can be identified to discover impending nerve injury;
③ Timely finding recurrent laryngeal nerve injury, immediately stopping the invasive operation, so that the recurrent laryngeal nerve injury can be recovered in the operation or the severity of the injury can be reduced, and permanent nerve injury can be avoided;
④ The nerve function can be recovered after the electromyographic signal is lost in the operation is predicted, and if the lost electromyographic signal is found to be recovered to 50% of the initial value before the operation is finished, the vocal cord function of the patient after the operation can be recovered to be normal.
The APS electrode continuously gives out stimulation on the vagus nerve, the stimulation frequency is 30 times/min, if the continuous stimulation on the recurrent laryngeal nerve is directly carried out, the nerve and the vocal cords are fatigued or even damaged, the APS electrode generally does not cause the fatigued, and meanwhile, the discontinuous nerve monitoring is not influenced during operation. Literature studies indicate that nerve monitoring has a stimulation intensity of 1-2 mA, the continuous stimulation frequency is not higher than 30 times/min, and continuous stimulation of the vagus nerve does not cause adverse reactions of heart and lung. Patients older with late atrioventricular block and/or cardiac pacemakers can also be safely subjected to intraoperative continuous nerve monitoring. Experiments show that compared with intermittent nerve monitoring, continuous nerve monitoring can effectively reduce the incidence rate of postoperative permanent vocal cord paralysis, and the difference has statistical significance.
The above as well as additional features, aspects, and advantages of the present application will become more readily apparent with reference to the following detailed description.
Detailed Description
In order to make the objects, technical solutions and advantages of the embodiments of the present invention more clear, the technical solutions of the embodiments of the present invention will be clearly and completely described below in conjunction with the embodiments of the present invention. It will be apparent that the described embodiments are some, but not all, embodiments of the invention. All other embodiments, which can be made by a person skilled in the art without creative efforts, based on the described embodiments of the present invention fall within the protection scope of the present invention.
Unless defined otherwise, technical or scientific terms used herein should be given the ordinary meaning as understood by one of ordinary skill in the art to which this invention belongs. The terms "first," "second," and the like in the description and in the claims, are not used for any order, quantity, or importance, but are used for distinguishing between different elements. Likewise, the terms "a" or "an" and the like do not denote a limitation of quantity, but rather denote the presence of at least one.
An intraoperative continuous nerve monitoring system, the system includes nerve stimulating module, myoelectricity collection module, display and alarm module, nerve stimulating module is used for stimulating nerve, myoelectricity collection module is used for gathering neural myoelectricity data, display and alarm module includes: the acquisition module acquires the original electromyogram data acquired by the electromyogram acquisition module at the current time; the prediction module is used for calculating to obtain predicted electromyogram data by adopting a neural network algorithm according to the historical electromyogram data; the trusted data calculation module is used for calculating trusted electromyogram data according to the original electromyogram data and the predicted electromyogram data; the correction coefficient calculation module is used for calculating and obtaining a correction coefficient according to the original electromyogram data and the trusted electromyogram data; the correction module is used for correcting the original electromyogram data by multiplying the correction coefficient to obtain corrected electromyogram data; the display module displays the original electromyogram data and the corrected electromyogram data; and the alarm module is used for alarming according to the preset threshold value and the corrected electromyogram data. The electromyogram data is selected from one or more of amplitude value, latency, period.
The predicted electromyogram data may be calculated according to a neural network algorithm. Specifically, a plurality of groups of amplitude values, latency and period parameters are input into a processing module, the input parameters are used as a training set of a neural network, a neural network weight matrix is obtained, and then the corresponding relation between the multidimensional parameters and electromyogram data is determined. The amplitude value, the latency period and the period parameter are in a predictable corresponding relation with the predicted electromyogram data, and in general, the amplitude value, the latency period and the period parameter are all related to each other and are not random data, and the next set of amplitude value, latency period and period parameter data range can be judged through a plurality of sets of amplitude values, latency periods and period parameters.
After the predicted electromyogram data is obtained, a correction coefficient can be obtained through the comparison of the original electromyogram data and the predicted electromyogram data, and the coefficient can be obtained by adopting the average value of the original electromyogram data and the predicted electromyogram data or giving different weights to the original electromyogram data and the predicted electromyogram data, and then calculating. By means of the modification coefficient, the modified electromyogram data can be further multiplied by the original electromyogram data to obtain modified electromyogram data, and the modified electromyogram data can be used for alarming.
Meanwhile, in order to facilitate the observation of doctors, the original data and the correction data can be displayed simultaneously.
The display and alarm module further comprises a historical data updating decision module, and judges whether the correction coefficient is within a preset threshold range according to the correction coefficient obtained by the correction coefficient calculation module, if so, the historical electromyogram data is not updated, and if not, a group of new historical electromyogram data is replaced.
The myoelectricity acquisition module is used for simultaneously acquiring left and right side nerve myoelectricity, and if the ratio of left and right side nerve myoelectricity data at the current time exceeds a preset threshold value, the nerve myoelectricity data at the previous time is used as nerve myoelectricity data at the current time.
The left and right nerve is left and right vagus nerve or left and right recurrent laryngeal nerve.
The stimulation intensity of the nerve stimulation module is 1-2 mA, and the continuous stimulation frequency is not higher than 30 times/min.
An intraoperative continuous nerve monitoring method comprises the following steps of acquiring original electromyography data at the current time; a prediction step, according to the historical electromyogram data, calculating to obtain predicted electromyogram data by adopting a neural network algorithm; a trusted data calculation step of calculating trusted electromyogram data according to the original electromyogram data and the predicted electromyogram data; a correction coefficient calculation step of calculating a correction coefficient according to the original electromyogram data and the trusted electromyogram data; a correction step of multiplying the original electromyogram data by a correction coefficient to correct the original electromyogram data to obtain corrected electromyogram data; a display step of displaying original electromyogram data and corrected electromyogram data; and alarming according to the preset threshold value and the corrected electromyogram data.
The monitoring method further comprises a historical data updating decision step, wherein whether the correction coefficient is within a preset threshold range is judged according to the correction coefficient obtained by the correction coefficient calculation module, if yes, the historical electromyogram data are not updated, and if not, a group of new historical electromyogram data are replaced. Generally, the electromyogram data of different ages, sexes and physical states are different, so that a more accurate prediction is required to more efficiently judge the abnormality of the electromyogram data, and the accuracy of the historical data is judged by correcting the coefficient, which is particularly important. Thereby replacing different historical data.
And in the monitoring process, the left and right nerve myoelectricity is collected simultaneously, and if the ratio of the left and right nerve myoelectricity data at the current time exceeds a preset threshold value, the nerve myoelectricity data at the previous time is used as the nerve myoelectricity data at the current time. In general, the amplitude value of the left vagus nerve electromyography is 300-1200 mu V, the latency period is 5-7ms, and the period is 7-12; the amplitude value of the right vagus nerve electromyogram is 250-1250 mu V, the latency period is 3-5ms, and the period is 6-12; the amplitude value of the left recurrent laryngeal nerve electromyogram is 100-1400 mu V, the latency period is 2-4ms, and the period is 5-10; the amplitude value of the right recurrent laryngeal nerve electromyogram is 200-1300 mu V, the latency period is 2-4ms, and the period is 5-10. Experiments show that the amplitude values, the incubation periods and the periods on the left side and the right side are closely related, and the method can be used for judging whether the data are accurate or not.
The APS electrode continuously gives out stimulation on the vagus nerve, the stimulation frequency is 30 times/min, if the continuous stimulation on the recurrent laryngeal nerve is directly carried out, the nerve and the vocal cords are fatigued or even damaged, the APS electrode generally does not cause the fatigued, and meanwhile, the discontinuous nerve monitoring is not influenced during operation. Literature studies indicate that nerve monitoring has a stimulation intensity of 1-2 mA, the continuous stimulation frequency is not higher than 30 times/min, and continuous stimulation of the vagus nerve does not cause adverse reactions of heart and lung. Patients older with late atrioventricular block and/or cardiac pacemakers can also be safely subjected to intraoperative continuous nerve monitoring. Experiments show that compared with intermittent nerve monitoring, continuous nerve monitoring can effectively reduce the incidence rate of postoperative permanent vocal cord paralysis, and the difference has statistical significance.
While the fundamental and principal features of the invention and advantages of the invention have been shown and described, it will be apparent to those skilled in the art that the invention is not limited to the details of the foregoing exemplary embodiments, but may be embodied in other specific forms without departing from the spirit or essential characteristics thereof. The present embodiments are, therefore, to be considered in all respects as illustrative and not restrictive, the scope of the invention being indicated by the appended claims rather than by the foregoing description, and all changes which come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein.
Furthermore, it should be understood that although the present disclosure describes embodiments, not every embodiment is provided with a separate embodiment, and the description is provided for clarity only, and those skilled in the art will recognize that the embodiments of the disclosure may be combined appropriately to form other embodiments that will be understood by those skilled in the art.
Claims (9)
1. The utility model provides a continuous nerve monitoring system in art, its characterized in that, the system includes nerve stimulation module, myoelectricity collection module, display and alarm module, nerve stimulation module is used for stimulating nerve, the myoelectricity collection module is used for gathering neural myoelectricity data, display and alarm module includes:
the acquisition module acquires the original electromyogram data acquired by the electromyogram acquisition module at the current time;
The prediction module is used for calculating to obtain predicted electromyogram data by adopting a neural network algorithm according to the historical electromyogram data;
The trusted data calculation module is used for calculating trusted electromyogram data according to the original electromyogram data and the predicted electromyogram data;
The correction coefficient calculation module is used for calculating and obtaining a correction coefficient according to the original electromyogram data and the trusted electromyogram data;
the correction module is used for correcting the original electromyogram data by multiplying the correction coefficient to obtain corrected electromyogram data;
The display module displays the original electromyogram data and the corrected electromyogram data;
And the alarm module is used for alarming according to the preset threshold value and the corrected electromyogram data.
2. An intraoperative continuous nerve monitoring system according to claim 1 wherein the electromyographic data is selected from one or more of amplitude value, latency, period.
3. The intraoperative continuous nerve monitoring system of claim 1, wherein the display and alarm module further comprises a historical data updating decision module for judging whether the correction coefficient is within a preset threshold range according to the correction coefficient obtained by the correction coefficient calculation module, if so, not updating the historical electromyogram data, and if not, replacing a set of new historical electromyogram data.
4. The intraoperative continuous nerve monitoring system of claim 1, wherein the myoelectricity acquisition module is configured to simultaneously acquire left and right nerve myoelectricity, and if the ratio of left and right nerve myoelectricity data at the current time exceeds a preset threshold, the nerve myoelectricity data at the previous time is used as nerve myoelectricity data at the current time.
5. An intraoperative continuous nerve monitoring system according to claim 4, wherein the left and right side nerves are left and right side vagus nerves or left and right side recurrent laryngeal nerves.
6. An intraoperative continuous nerve monitoring system according to claim 1 wherein the nerve stimulation module has a stimulation intensity of 1-2 mA and a continuous stimulation frequency of no more than 30 times/min.
7. A method of continuous nerve monitoring, the method comprising the steps of:
An acquisition step of acquiring original electromyogram data at the current time;
A prediction step, according to the historical electromyogram data, calculating to obtain predicted electromyogram data by adopting a neural network algorithm;
A trusted data calculation step of calculating trusted electromyogram data according to the original electromyogram data and the predicted electromyogram data;
A correction coefficient calculation step of calculating a correction coefficient according to the original electromyogram data and the trusted electromyogram data;
a correction step of multiplying the original electromyogram data by a correction coefficient to correct the original electromyogram data to obtain corrected electromyogram data;
A display step of displaying original electromyogram data and corrected electromyogram data;
An alarm step, namely alarming according to a preset threshold value and corrected electromyogram data;
The electromyographic data is selected from one or more of amplitude value, latency period and period.
8. The method according to claim 7, further comprising a step of updating the historical data, wherein the step of determining whether the correction factor is within a predetermined threshold is based on the correction factor obtained by the correction factor calculation module, if so, the historical electromyogram data is not updated, and if not, a new set of the historical electromyogram data is replaced.
9. The method according to claim 7, wherein the left and right nerve myoelectricity are collected simultaneously during the monitoring process, and if the ratio of the left and right nerve myoelectricity data at the current time exceeds a preset threshold, the nerve myoelectricity data at the previous time is used as the nerve myoelectricity data at the current time.
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| AU2015258176A1 (en) * | 2008-10-15 | 2015-12-03 | Nuvasive, Inc. | Neurophysiologic monitoring system and related methods |
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| US8989855B2 (en) * | 2009-01-30 | 2015-03-24 | Medtronic Xomed, Inc. | Nerve monitoring during electrosurgery |
| KR102273684B1 (en) * | 2012-11-10 | 2021-07-07 | 더 리젠츠 오브 더 유니버시티 오브 캘리포니아 | Systems and methods for evaluation of neuropathologies |
| CN106510703A (en) * | 2016-12-09 | 2017-03-22 | 肖玉根 | Recurrent laryngeal nerve real-time monitor and monitoring method |
| GB201708654D0 (en) * | 2017-05-31 | 2017-07-12 | Verity Nigel Charles | Apparatus and process for neuromuscular stimulation |
| CN109498008A (en) * | 2018-12-26 | 2019-03-22 | 江苏百宁盈创医疗科技有限公司 | A kind of wireless neural monitor system and equipment |
| US11813053B2 (en) * | 2019-08-09 | 2023-11-14 | GE Precision Healthcare LLC | Method and system for predicting patient recovery time from neuromuscular block |
| CN111920410A (en) * | 2020-08-12 | 2020-11-13 | 上海诺诚电气股份有限公司 | Diabetes early-stage screening system and method based on big data |
| CN217430032U (en) * | 2022-03-30 | 2022-09-16 | 重庆大学附属肿瘤医院 | In-vivo and in-vitro dual-purpose laryngeal recurrent nerve continuous real-time monitoring system |
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| AU2015258176A1 (en) * | 2008-10-15 | 2015-12-03 | Nuvasive, Inc. | Neurophysiologic monitoring system and related methods |
| CN103751909A (en) * | 2014-01-23 | 2014-04-30 | 上海诺诚电气有限公司 | Real-time feedback intelligent electrical stimulation device and stimulation method thereof |
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