硬膜外脊髓电刺激对慢性脊髓损伤后自主神经功能的影响  

Effect of epidural electrical stimulation on autonomic nervous system functions after chronic spinal cord injury

作　　者：戎宏涛[1] 李思鹏 郑博雯 张锐光 朱涛[1] Rong Hongtao;Li Sipeng;Zheng Bowen;Zhang Ruiguang;Zhu Tao(Department of Neurosurgery,General Hospital of Tianjin Medical University,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院神经外科,天津300052

出　　处：《中华神经外科杂志》2023年第9期892-898,共7页Chinese Journal of Neurosurgery

基　　金：天津市科技计划项目(19ZXDBSY00040);天津市卫生健康委员会科技项目(ZC20175)。

摘　　要：目的观察硬膜外脊髓电刺激(EES)对慢性脊髓损伤(SCI)后部分自主神经功能的影响。方法前瞻性纳入2020年1月至2022年3月天津医科大学总医院神经外科行EES治疗的慢性SCI患者。分期植入EES装置,EES植入后第3天开机,进行约10 d的测试观察(Ⅰ期终点);有意愿继续治疗者植入可充电永久刺激器装置,术后1年进行评估(Ⅱ期终点)。采用美国脊髓损伤协会(ASIA)分级标准评估脊髓功能,采用疼痛数字分级量表评分(NRS)、轻触觉(LT)和针刺觉(PP)评分、改良Ashworth量表(MAS)、神经源性膀胱症状评分(NBSS)和神经源性肠道功能障碍(NBD)评分、脊髓损伤后自主神经系统评价工具(ISAFSCI)、等量表评估EES对疼痛、浅感觉、肌张力、排便和排尿、排汗等自主神经功能的影响。采用尿动力学及肛直肠动力学检查评估排便和排尿功能,采用表面肌电图记录下肢肌电反应,采用功能性近红外光谱(fNIRS)技术评估下肢浅表组织灌注和氧代谢。结果共纳入4例患者,均完成Ⅰ期评估,2例完成Ⅱ期评估。Ⅰ、Ⅱ期终点各有1例患者ASIA分级提高。Ⅰ期终点,4例患者的疼痛和肌肉痉挛均获得不同程度的缓解,NRS由术前的平均6.50分降至3.00分,MAS由平均15.25分降至12.87分;ISAFSCI量表评分显示,所有患者下肢的排汗功能均有不同程度改善;表面肌电图记录到EES对下肢的不自主肌肉痉挛有显著的抑制作用。Ⅱ期终点评估上述指标改善程度均保持良好。Ⅰ期和Ⅱ期终点评估LT和PP评分变化均不明显。I期终点,4例患者评估排尿和排便功能的NBSS和NBD平均评分分别由术前的42.5分、21.00分,降至35.75分、17.00分;尿动力学及肛直肠动力学相关指标均有不同程度改善。Ⅱ期终点评估排尿和排便功能进一步改善。Ⅰ期终点,fNIRS观察结果显示,EES可以显著提高下肢浅层组织的血红蛋白浓度。结论初步研究显示,EES有助于改善慢性SCI患者�Objective To observe the effect of epidural spinal cord electrical stimulation(EES)on some autonomic nervous functions after chronic spinal cord injury(SCI).Methods The patients with chronic SCI who were treated with EES in the Department of Neurosurgery,General Hospital of Tianjin Medical University from January 2020 to March 2022 were prospectively enrolled into this study.The EES device was implanted in stages,and the EES was turned on the 3rd day after EES implantation,and the test observation was carried out for about 10 days(phaseⅠendpoint).Those who wish to continue treatment are placed with a rechargeable permanent stimulator device and evaluated 1 year after surgery(stageⅡendpoint).The spinal cord function was assessed by the American Spinal Injury Association(ASIA)grading standard,and the numeric rating scale(NRS),light touch and acupuncture scores(LT,PP),the International Standards to document remaining Autonomic Function after Spinal Cord Injury(ISAFSCI),the modified Ashworth scale(MAS),the neurogenic bladder symptom score(NBSS)and the neurogenic bowl dysfunction(NBD)score were used to assess the effect of EES effect on pain,sensation,muscle tone,defecation and urination,sweating and other autonomic nervous functions.Urinary dynamics and anorectal dynamics were used to assess the defecation and urination function,surface Electromyography(EMG)was used to record the lower limb myoelectric response,and functional near-infrared spectroscopy(fNIRS)was used to assess the lower limb superficial tissue perfusion and oxygen metabolism.Result A total of 4 patients were included,all completed PhaseⅠassessment,and 2 completed PhaseⅡassessment.There was an increase in ASIA grading in 1 patient at the endpoints of stageⅠand stageⅡ.At the end point of PhaseⅠ,all 4 patients achieved various degrees of relief in pain and muscle spasms.NRS decreased from preoperative 6.50 points to 3.00 points,and MAS decreased from 15.25 to 12.87.EMG recorded a significant inhibitory effect of EES on involuntary muscle s

关 键 词：硬膜外脊髓电刺激 慢性脊髓损伤 自主神经功能 

分 类 号：R651.2[医药卫生—外科学]