CAJ | 학술논문

目的为术中应用皮层体感诱发电位(CSEP)监测脊髓功能,预防术后运动功能障碍提供理论依据. 方法 33只新西兰大白兔采用随机数字表法分为6组,对照组8只用于排除麻醉和手术对诱发电位的影响,余25只根据结扎左肾动脉和动脉分叉间节段性脊髓供血动脉的条数分为5组(n=5),分别为1～5根组.记录各组动物麻醉后基线诱发电位,血管结扎后急性期诱发电位,结扎后30 min、2 d后诱发电位.动物麻醉清醒后、血管结扎后2 d时进行运动功能评分,并取缺血中心区标本行HE染色. 结果潜伏期对缺血性损伤不敏感,实验组与对照组差异无统计学意义(P>O.05);波幅变化复杂,对运动功能特异性差,2、3、4根组均观察到急性期波幅先降低又逐渐恢复趋势,波幅的变化可以反映脊髓的病理损害程度和运动功能. 结论缺血急性期CSEP波幅变化复杂,对运动功能特异性差,波形记录的信号需要平均化过程,造成结果解释的延迟,术中应联合运动诱发电位对脊髓功能进行监测.
목적 위술중응용피층체감유발전위(CSEP)감측척수공능,예방술후운동공능장애제공이론의거. 방법 33지신서란대백토채용수궤수자표법분위6조,대조조8지용우배제마취화수술대유발전위적영향,여25지근거결찰좌신동맥화동맥분차간절단성척수공혈동맥적조수분위5조(n=5),분별위1～5근조.기록각조동물마취후기선유발전위,혈관결찰후급성기유발전위,결찰후30 min、2 d후유발전위.동물마취청성후、혈관결찰후2 d시진행운동공능평분,병취결혈중심구표본행HE염색. 결과 잠복기대결혈성손상불민감,실험조여대조조차이무통계학의의(P>O.05);파폭변화복잡,대운동공능특이성차,2、3、4근조균관찰도급성기파폭선강저우축점회복추세,파폭적변화가이반영척수적병리손해정도화운동공능. 결론 결혈급성기CSEP파폭변화복잡,대운동공능특이성차,파형기록적신호수요평균화과정,조성결과 해석적연지,술중응연합운동유발전위대척수공능진행감측.
Objective To provide the theoretical basis for the application of cortical somatosensory evoked potential (CSEP) in monitoring the function of the spinal cord to prevent postoperative neurological dysfunction. Methods Thirty-three New Zealand rabbits were randomly divided into 6 groups: 8 were chosen as control group to eliminate the influence of anesthesia and surgery on the evoked potential; the other 25 were assigned to 5 sub-experimental groups (n=5) according to the artery number being ligatured in the left renal arteries and the spinal arteries. Baseline evoked potential in each group was noted immediately after anesthesia; the CSEP were recorded at different time points (before vascular ligation, 30 min and 2 d after vascular ligation). Motor functions were assessed after narcotic conscious and 2 d after vascular ligation. The specimens were taken for HE staining. Results The latency was not sensitive to spinal cord ischemia and no significant difference of that was found between the experimental groups and the control group (P>0.05); except that, the changes of theamplitudes were very complex and the specificity of motor function was decreased. The amplitude reduced and then gradually restored in the 2, 3 and 4 levels of ligation. The changes of amplitude could indicate the degree of pathological damage in the spinal cord and its motor function. Conclusion Complex amplitude of somatosensory evoked potential can be found in the acute phase of ischemia in the spinal cord. Specificity of motor function is poor resulting from its signal averaging process. Motor evoked potential monitoring in the operation should also be added in the detection of the spinal cord.