颈椎损伤后手术中脊髓保护措施的效果探讨  

The clinical observation of protection of spinal cord during the cervical vertebral surgery

作　　者：汪晨[1] 李明全[1] 张英民[1] 刘慧芬[1] 徐新智[1] 袁志[1] 张亚静[1] 

机构地区：[1]解放军第四军医大学西京医院,陕西西安710032

出　　处：《中国临床康复》2002年第10期1448-1449,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的探讨颈椎损伤后手术中脊髓保护措施的效果。方法强迫位下清醒/快速诱导气管插管后,部分患者行控制性降压、脱水、利尿、适度过度通气、皮层体感诱发电位(CSEP)监测;截瘫患者行双下肢弹性绷带缠裹。结果快速诱导插管较清醒插管难度明显降低(P<0.05),术后并发症减少;控制性降压明显减少术中出血量(P<0.01),显露清晰,方便椎管内操作;脱水、利尿、适度过度通气使椎管内压明显降低,硬膜、脊髓损伤减少;截瘫患者弹性绷带缠裹后,术中脊髓血供改善;CSEP监测可规避术中误伤脊髓的发生。结论颈椎手术中脊髓保护应从诱导插管、术中管理多个环节加以落实,方可获得理想的脊髓保护效果。Objective To find out the effects of protection measure for spinal cord.Method After waken /fast induced tracheal i ntu-bation under the forced position,certain patients were used by induced h ypotension,dehydrate,diuresis,a vailable hyperventilation,cortic al somatosensory evoked potential(CSEP)monitoring during spinal surgery;T he lower limbers of paraplegia patie nts were twined by flexible bandage.Results The difficult tracheal intubation r ate under fast induced was more less t han that under waken intubation(P<0.05),which fallen the cases of post-operative c omplication The blood loss under induced hypotension was greatly reduce d comparing with control(P<0.01),which made the operation field clea rly and convenience surgeon to perfo rm in vertebral catheter;vertebral catheter pressure(VCP)was decreased by dehydrate,diuresis an d available hyperventilation,whic h evade the cervical putamen and spin al cord to be harm during cervical vertebral surgery;The circulation condition of spinal cord of paraplegia patients was improved quietly aft er twined by flexible bandage;CSEP monitoring can elude spinal cord to b e injured.Conclusion To realize the protection effects fo r spinal cord perfectly,certain measure would be carried out at multi-tache as procession of intubation,intro-operativ e management.etc in cervical verteb ral surgery.

关 键 词：颈椎损伤 脊髓保护 颈椎手术 气管插管 皮层体感诱发电位 弹性绷带 

分 类 号：R681.5[医药卫生—骨科学]