不同程度骶髓缺血兔坐骨海绵体肌CPMEP的变化特点及骶髓损伤情况  

Change charateristics of CPMEP and sacral spinal cord injury in rabbits with different degrees of sacral spinal cord ischemia ischiocavernosus musle

作　　者：宋启民[1,2] 张志龙 刘兴明 戴超 程彦昊[1] 车峰远[2] 刘于海 Song Qimin;Zhang Zhilong;Liu Xingming;Dai Chao;Cheng Yanhao;Che Fengyuan;Liu Yuhai(Department of Neurosurgery,Linyi People's Hospital,Linyi 276000,China;Linyi Key Laboratory of Neurophysiology,Linyi 276000,China;Department of Neurosurgery,Linyi Central Hospital,Linyi 276400,China)

机构地区：[1]临沂市人民医院神经外科,临沂276000 [2]临沂市神经生理学重点实验室,临沂276000 [3]临沂市中心医院神经外科,临沂276400

出　　处：《中华解剖与临床杂志》2024年第11期759-765,共7页Chinese Journal of Anatomy and Clinics

基　　金：山东医药卫生科技发展计划(202304040611);临沂市重点研发计划(2022YX0062)。

摘　　要：目的:探讨不同程度骶髓缺血兔模型中坐骨海绵体肌皮层阴部运动诱发电位(CPMEP)的波形变化特点及骶髓损害情况。方法:选取健康成年雄性新西兰大白兔42只,按数字表法随机分为对照组和实验A组、B组、C组、D组、E组,共6组,每组7只。42只实验兔在头部生殖运动区(矢状缝旁开2 mm的冠状缝上)打直径约1 mm的骨孔,将银球式刺激电极阳极置于骨孔上、针式刺激电极阴极置于与阳极间距约6 mm的冠状缝前缘额中线附近;记录电极的阳极和阴极均放置在刺激部位对侧的坐骨海绵体肌,两电极之间的距离约5 mm。模型制备:实验兔均手术分离左肾动脉和左、右髂总动脉分叉间的腰动脉;对照组模拟腰动脉结扎操作,但不结扎腰动脉;实验A组、B组、C组、D组、E组分别结扎左肾动脉和髂总动脉分叉间,1、2、3、4、5根腰动脉。观察项目:(1)观察各组实验兔结扎(包括模拟结扎)腰动脉后2 h内CPMEP波形变化特点,记录腰动脉结扎完成至CPMEP波形稳定所需要的时间;比较各组实验兔腰动脉结扎前和结扎后30 min CPMEP的波幅、波幅百分率、潜伏期的差异。(2)腰动脉结扎后48 h处死各组实验兔,取腰骶膨大中心区域缺血脊髓前角组织HE染色病理检查,比较各组实验兔骶髓损伤程度和脊髓前角死亡神经元细胞百分率。结果:42只实验兔,实验过程中实验C组和D组各有1只实验兔死亡,其余40只实验兔均顺利完成造模和术后评估,模型成功率95.2%(40/42)。(1)对照组和实验A组实验兔腰动脉结扎后2 h内未见CPMEP波形出现明显变化;实验B组、C组、D组和E组实验兔血管结扎后CPMEP波形即刻开始变化,表现为潜伏期延长、波幅降低,其中E组有3只实验兔CPMEP波形消失,然后各组实验兔CPMEP波形逐渐稳定,结扎完成至CPMEP波形稳定所需要的时间分别为(1.5±0.8)、(1.8±1.1)、(2.3±1.1)和(2.1±1.3)min。(2)CPMEP波幅、潜伏期组内比较:对Objective This study aimed to investigate the waveform change characteristics of ischiocavernosus muscle cortical pudendal motor evoked potential(CPMEP)and the condition of sacral spinal cord injury with different degrees of sacral cord ischemia of rabbit models.Methods Forty-two healthy adult male New Zealand white rabbits were selected and randomly divided into control group and experiment A-E groups by number table method,with six groups with seven rabbits in each group.A bone hole with a diameter of approximately 1 mm was drilled in the 42 experimental rabbits'head in the reproductive motor area(on the coronal suture 2 mm beside the sagittal suture).Silver ball stimulus electrode anodes were placed on the bone hole,and needle stimulating electrode cathodes were placed at the frontal midline of the anterior margin of coronal suture of the rabbit,with a distance of approximately 6 mm.The recording anode and cathode electrodes were placed in the ischiocavernous muscles of the stimulation opposite sites,with a distance of approximately 5 mm.Model establishment:the experimental rabbits in the control group underwent surgical separation of the lumbar arteries between the left renal artery and bifurcation of left and right common iliac arteries,simulating lumbar arterial ligation but not ligating the lumbar arteries.The experimental rabbits in groups A-E were ligated with 1-5 lumbar arteries between the left renal artery and bifurcation of left and right common iliac arteries,respectively.Observation items:(1)the change in CPMEP waveforms were observed for 2 h after lumbar arterial ligation.The times required from the completion of lumbar arterial ligation to the stability of the CPMEP waveforms were recorded.The CPMEP amplitudes,latencies,and percentage of amplitudes before and 30 min after lumbar arterial ligation were compared.(2)The experimental rabbits in each group were killed 48 h after lumbar arterial ligation,and the spinal cord ischemic anterior horn tissues in the central area of lumbosacral enlargement w

关 键 词：脊髓缺血 模型 动物 坐骨海绵体肌 诱发电位 皮层阴部运动诱发电位 监测 生理学 兔 

分 类 号：R651.2[医药卫生—外科学] R-332[医药卫生—临床医学]