球海绵体括约肌肌反射在公兔骶髓缺血急性期的变化  

Changes of bulbocavernosus sphincter reflex in male rabbit models of sacral spinal ischemia during early stage

作　　者：宋启民[1] 唐先扩 栾金利 刘壮[3] 张健[1] 费昶[1] 戴超[1] 程彦昊[1] 

机构地区：[1]临沂市人民医院神经外科,276000 [2]山东省东平县人民医院神经外科,271500 [3]潍坊医学院神经外科,潍坊262000

出　　处：《中华神经医学杂志》2017年第3期279-284,共6页Chinese Journal of Neuromedicine

基　　金：山东医药卫生科技发展计划（2015WS0375）

摘　　要：目的探讨球海绵体括约肌肌反射（BCR）在公兔不同水平骶髓损伤模型急性期的变化特点及其对脊髓功能的预测作用，为其在显微手术中应用保护脊髓功能提供理论依据。方法36只雄性新西兰大白兔按随机数字表法分为实验组（n=30）和对照组（n=6）。实验组按照尾头方向结扎腰动脉的水平分为1根、2根、3根、4根和5根亚组，分别结扎左肾动脉与动脉分叉之间1根、2根、3根、4根或5根腰动脉。腰动脉结扎后连续记录BCR2h。各组分别在手前和术后2d行双盲法Tarlov下肢运动功能评分。术后2d取缺血区骶髓标本进行HE染色，观察骶髓缺血区病理变化。结果对照组麻醉后不同时间点的BCR波幅和潜伏期比较差异无统计学意义（P〉0．05）；手术前和手术操作后不同时间点的BCR波幅和潜伏期比较差异无统计学意义（P〉0．05）。结扎1根组结扎后未见BCR波变化，结扎2根组、3根组、4根组和5根组结扎后BCR即刻开始变化，表现为潜伏期即刻开始延长和波幅即刻开始降低，分别经过（0．7±0．4）、（0．7±0.3）、（0．7±0．3）、（0．6±0．3）min后波恢复平稳；BCR的波幅变化与结扎2d后Tarlov下肢运动功能评分呈正相关（r=0．791，P=0．000）。HE染色可见：对照组、1根组和2根组骶髓组织结构完整；3根组骶髓结构基本完整：5根组骶髓正常结构基本消失；4根组介于3根组与5根组骶髓损伤之间。结论公兔BCR的波幅和潜伏期对骶髓缺血性损伤敏感，可以在骶髓缺血急性期内发现缺血性损伤．为其在显微手术中应用预防男性不可逆性骶髓损伤的发生提供了理论依据。Objective To explore the changes of bulbocavemosus sphincter reflex （BCR） in male rabbit models of spinal cord ischemia injury of different levels at acute stage and their values in predicting spinal cord functions, and provide theoretical basis for protecting the spinal cord function by neurophysiology examination in clinical microsurgical operation. Methods Thirty-six adult New Zealand rabbits were randomly divided into 6 groups： a control group （n=6） was used to eliminate the effects of anesthesia and surgery on BCR; rabbits in the experimental group （n=30） were randomly divided into 5 groups （n=6） according to different levels of lumbar arteries being ligatured between the left renal artery and arterial bifurcate （subgroups of one, two, three, 4 and 5 lumbar arteries being ligatured）. BCR was recorded continuously within two h of ligation; rabbits in each group were subjected to double-blind Tarlov lower limb motor function scale before and 2 d after surgery; and ischemic spinal cord specimens were performed hematoxylin and eosin （HE） staining to observe pathological changes in sacral spinal cord ischemic areas after 2 days. Results There was no significant difference in BCR amplitude and latency between different time points after anesthesia （P〉0.05）; there was no significant difference in BCR amplitude and latency between different time points before and after operation （P〉0. 05）. There was no significant change in the amplitude of BCR before and after one lumbar artery ligation; however, the BCR amplitude immediately changed after ligaturing two, three, 4 or 5 lumbar arteries： the latency of BCR immediately began to extend and amplitude immediately began to reduce; amplitude was stable respectively after （0.7±0.4）, （0.7±0.3）, （0.7±0.3） and （0.6±0.3） min of ligation. The amplitude variation of BCR was positively correlated with Tarlov lower limb motor function scale scores 2 days after ligation （r=0.791, P=-0.0001）. HE staining showed that the

关 键 词：球海绵体肌反射 术中电生理监测 骶髓缺血损伤 可逆转期 公兔 

分 类 号：R651.2[医药卫生—外科学]