经颅电刺激运动诱发电位术中监测预防脊髓缺血性损伤的实验研究  

Prevention of spinal cord ischemic injury by intraoperative TceMEP monitoring:an experimental study

作　　者：宋启民[1] 杨卫忠[1] 陈春美[1] 王春华[1] 石松生[1] 贾建文[1] 房新蓉[1] 

机构地区：[1]福建医科大学附属协和医院神经外科福建省神经外科研究所,福州350001

出　　处：《中国微侵袭神经外科杂志》2010年第3期127-130,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：福建省卫生厅青年科研课题资助项目(编号:2008-2-26)

摘　　要：目的探讨术中经颅电刺激运动诱发电位(TceMEP)监测在脊髓髓内肿瘤切除术中对脊髓缺血性损伤的保护作用。方法将16只实验兔随机分为4组,4只/组;对照组用来确定TceMEP的最佳刺激强度,术前连续记录3h(30min/次),并于术中、术后不同时间点记录以排除麻醉、手术对诱发电位的影响;另3组分别结扎3、4、5根腰动脉,血管结扎后5min内记录TceMEP,并行运动功能评分,2d后取标本行苏木精-伊红染色。结果TceMEP波幅对缺血性脊髓损伤敏感;血管结扎后,可见波幅先降低后逐渐恢复,5min内均趋于稳定。TceMEP波幅变化与麻醉清醒后运动功能、结扎2d后运动功能和病理损伤程度均呈正相关,r分别为0.977、0.933、0.971,差异均有统计学意义(P<0.01)。结论术中TceMEP可敏感地反映缺血性脊髓损伤,可在脊髓缺血可逆期内发现缺血性损伤,有助于及时采取措施,预防不可逆性脊髓损伤的发生。Objective To study the protective effects of intraoperative monitoring with transcranial electrical motor-evoked potentials （TceMEP） on the spinal cord during the resection of intramedullary tumor. Methods Sixteen rabbits were randomly divided into 4 groups, 4 rabbits for each group： control group was a sham-operated group, in which the TceMEP was continuously recorded for 3 h before the operation （30 min a time）, and at different time points during and after the operation to rule out the influence of the operation and anesthesia on TceMEP and establish the optimal stimulation intensity; The other 3 groups underwent ligation of 3, 4, 5 lumbar arteries respectively. The TceMEP was recorded within 5 min after the ligation and the motor function was assessed. HE examination was performed 2 d later. Results The amplitudes of TceMEP are more sensitive than latencies to spinal cord ischemic damage. The amplitudes of ligation groups were all declined in early time period and gradually recovered to stable in within 5 minutes after ligation. The changes of TceMEP had positive correlations with motor function after anesthesia awareness and at 2 d after the ligation and the pathological damage, and the r value was 0.977, 0.933 and 0.971 respectively. Conclusions TceMEP is sensitive to spinal cord ischemic injury, which could be detected in the reversible stage, thus being helpful to prevent the irreversible spinal cord injury timely.

关 键 词：脊髓损伤 诱发电位 运动 监测 手术中 经颅电刺激 兔子 

分 类 号：R651.2[医药卫生—外科学] R741.044[医药卫生—临床医学]