体感诱发电位在腰椎间盘突出症术中监护的临床意义

目的探讨对腰椎间盘突出症进行术中体感诱发电位监护的临床意义。方法利用节段性皮神经刺激SEP技术对163例腰椎间盘突出症患者椎间盘切除术前、后进行检测随访,并将术中SEP监护组与非监护组的手术后功能改善结果进行对比。结果潜伏期缩短10%~15%或波幅增加>40%,提示愈后良好;监测电位指标平稳,或潜伏期缩短<10%,或波幅增加<30%,可继续进行手术操作,提示术后效果会受到轻度影响;监测电位指标出现暂时性波动,可在15~20 m in内恢复到基础电位,应在电位出现波动时暂停手术操作,提示术后效果会受到较大影响。结论节段性皮神经刺激SEP术中监护是腰椎间盘突出症手术中疗效评定和指导术中操作客观而有效的方法。     

富血小板血浆联合骨髓间充质干细胞对大鼠脊髓损伤的作用

摘要:目的　观察富血小板血浆（PRP）与骨髓间充质干细胞（BMSCs）联合应用对大鼠脊髓损伤的作用。方法　Sprague-Dawley（SD）大鼠40只,100～150 g,无特定病原体（SPF）级,随机将其分为4个组,分别为模型对照组、PRP（30×109/L）组、BMSCs（1×106/ml）组、PRP与BMSCs联合组,每组10只。使用打击装置造成大鼠T10段脊髓的冲击伤,建立大鼠脊髓损伤模型。术后PRP组在损伤段脊髓注入RPR,BMSCs组注入BMSCs,PRP与BMSCs联合组注入BMSCs与PRP复合物,每组分别注入1 ml。模型对照组不注入任何物质。术前3 d和术后12周对大鼠进行Basso-Beattie-Bresnahan（BBB）运动功能评分。造模后第12周,对大鼠小腿后侧皮肤感觉进行躯体感觉诱发电位检查,记录潜伏期时间和波幅大小。检查结束后处死动物,取出伤段脊髓组织,冷冻切片后进行苏木精-伊红（HE）染色,并观测伤段脊髓残存组织面积。结果　PRP组、BMSCs组、PRP与BMSCs联合组的后肢运动功能评分明显高于模型对照组,差别有统计意义（P＜0.05）。与术前相比,模型对照组的大鼠脊髓体感诱发电位（SSEP）潜伏期延长且诱发电位波幅减少。与模型对照组相比,PRP与BMSCs治疗组的SSEP潜伏期减短与诱发电位波幅上升（P＜0.05）。治疗组的受伤段脊髓残存组织面积与模型对照组相比有所增加（P＜0.05）,PRP与BMSCs联合治疗组效果最好。结论　PRP、BMSCs均可提高脊髓损伤大鼠后肢运动功能,缩短体感诱发电位（SEP）潜伏期和提高诱发电位波幅,增加受伤段脊髓残存组织面积,从而修复损伤脊髓。     

脑干听觉诱发电位在术中监测中的应用

脑干听觉诱发电位是指给耳高频短声刺激后在大脑皮层记录到的电位,临床广泛用于颅脑肿瘤的手术监测中,术中通过对潜伏期和波幅的监测,对帮助术者保护神经功能及判断预后脑干功能有重要价值。     

慢性正己烷中毒患者脑诱发电位慢性正己烷中毒患者脑诱发电位的临床观察

目的观察慢性正己烷中毒患者的脑诱发电位的改变,探讨其改变的机理。方法对38例慢性正己烷中毒患者(正己烷中毒组)进行了体感诱发电位(somatosensory evoked potential,SEP)及脑干听觉诱发电位(brain auditory evoked potential,BAEP)检测,并与20例正常健康人(正常对照组)进行比较。结果正己烷中毒组SEP外周(N9、N13)及皮层(P20、P25)电位的潜伏期及波幅较正常对照组显著延长(P0.001);正己烷中毒组BAEP的Ⅰ、Ⅲ、Ⅴ波的潜伏期及波幅也均较正常对照组显著延长(P0.001)。结论慢性正己烷中毒患者的脑诱发电位的异常提示存在慢性脑损害,需采用相应的脑保护措施进行预防和治疗。     

术中肢体被动运动干预对骨科特殊手术体位患者术中体位性臂丛神经损伤的效果探讨

目的：观察骨科特殊体位患者术中采取肢体被动运动干预对患者体位性臂丛神经损伤的影响。方法：选取2019年4～2021年3月收治的253例骨科手术患者为研究对象，术中采用神经电生理监护仪对患者上肢肌力情况进行监测，当患者上肢SEP下降后，采取肢体被动运动干预，观察患者上肢肌电力相关情况，包括SEP下降情况、肌力电阀值、肌力电潜伏期，以及SEP下降与恢复时间等。结果：253例患者中，有8例(3.16%)患者在术中出现上肢SEP下降，其中男性5例，女性3例，6例为腰椎手术患者，2例为胸椎手术患者，未见其他患者发生臂丛神经损伤；8例患者肌力电阀值和潜伏期在术前相对较高，干预前显著下降，经干预后显著上升(P<0.05); 8例上肢SEP下降患者在手术进行到(3.68±1.25)h(2～5 h)出现上肢肌力异常，对患者进行被动运动干预(48.17±12.69)min后，6例患者SEP恢复正常，另外2例患者在干预3 h内恢复。术后8～12个月对患者臂丛神经损伤情况进行随访，未发现臂丛神经损伤或上肢功能障碍患者。结论：骨科俯卧位术中采取被动运动干预护理，有利于患者SEP的恢复，对上肢臂丛神经损伤具...     

脊髓手术术中应用SEP监测26例分析

目前许多脊髓外科手术是在患者非清醒状态下进行的，而躯体感觉诱发电位（SEP）作为一种可连续监测脊髓功能的手段，自1977年Nash首次在脊柱矫形手术中应用，其临床应用价值逐渐引起重视。在国外，术中脊髓监护还具有法律效应。笔者所在医院自2007年1月至2008年11月采用SEP术中监测脊髓手术共26例，现对资料进行分析，报告如下。     

诱发电位监护在脑瘫患儿神经手术中的神经保护作用

【目的】 分析应用神经电生理技术对单纯痉挛型脑瘫患儿进行选择性后根阻断术(selective posterior rhizotomy,SPR)中的神经保护作用。 【方法】 对18例单纯痉挛型脑瘫选择性后根切除时,术中运用体感诱发电位(SEP)监测+肌源性运动诱发电位(MMEP)指导选择被阻断的神经后根,设定监护标准,记录术中变化,并对神经功能进行术前、术后比较。 【结果】 18例采用诱发电位监护患儿中,13例术前有不同程度的运动及感觉诱发电位改变,5例有周围运动诱发电位改变,体感诱发电位正常;术中10例手术全过程SEP平稳,术后未出现新的神经系统症状;5例麻醉后MMEP有波出现但不稳定,术后出现大小便异常,两周内恢复;3例在手术操作中出现SEP报警,其中1例经术者暂缓、暂停操作,查找原因,待波形恢复后继续手术,术后未出现新的神经损伤症状。 【结论】 SPR术中运用SEP+ MMEP监测指导,能客观、准确、最大限度地保留脊髓及脊神经功能,避免新的神经损伤尤其是圆锥、马尾神经损伤。     

俯卧位对脊髓手术患者体感诱发电位影响

目的观察俯卧体位对脊髓手术患者体感诱发电位（somatosensory evoked potentials, SEP）的影响。方法选择80名脊髓手术患者，按有无神经压迫症状分为阳性组（P组）与阴性组（N组），每组40名。两组患者均采用气管插管靶控输注瑞芬太尼、异丙酚全凭静脉麻醉，记录入室后静息时（T0）和俯卧位后1min（T1）、5min（T2）、10min（T3）的体感诱发电位P40的波峰潜伏期与波幅变化。结果P组T1、T2、T3时点P40波峰潜伏期和波幅与组内T0比较差异有统计学意义（P〈0．05），N组组内各时点比较差异无统计学意义（P〉0．05），P、N两组间各时点SEP值比较差异无统计学意义（P〉0．05）。结论俯卧位可引起有神经压迫症状的脊髓手术患者体感诱发电位的改变。     

糖尿病患者事件相关电位P300的变化及相关因素研究

目的探讨2型糖尿病患者事件相关电位P300的改变及其相关危险因素,并评价P300在糖尿病脑病中的诊断价值。方法对50例2型糖尿病患者和30例健康对照者进行事件相关电位P300检测,并分析P300波的潜伏期及波幅与糖尿病的病程、血脂及血压的关系。结果(1)糖尿病患者P300的潜伏期较对照组明显延长(P<0.01);且P300的波幅较对照组明显降低(P<0.05)。(2)糖尿病合并高血压组P300的潜伏期较对照组和糖尿病无高血压合并症组明显延长(P<0.01)。(3)随糖尿病病程的延长P300的潜伏期逐渐延长。(4)P300的潜伏期与糖尿病患者的血脂水平呈正相关。结论糖尿病患者存在明显认知功能障碍,事件相关电位P300可作为一项较客观、有价值的评价糖尿病患者认知功能的指标,并有助于糖尿病慢性脑病的早期诊断。     

介入治疗后的学龄期室间隔缺损患儿的认知能力及行为问题

目的研究介入治疗后的室间隔缺损(VSD)患儿的认知能力及行为问题,分析两者之间的关联性。方法选择自2010年1月-2012年12月在山东省立医院进行经导管介入封堵治疗的VSD 64例患儿。采用P300事件相关电位来评估VSD患儿的认知能力,另外采用儿童行为问题问卷来评估患儿的情绪和行为问题,分析这两者之间的关联性,并以56位正常对照儿童参与了本研究。结果 1)与对照组相比,VSD患儿在额叶和顶叶部位具有长的潜伏期,额叶和顶叶部位的波幅明显低于对照组;2)VSD的男童存在抑郁、体诉等行为问题,女童存在抑郁、强迫、社会退缩、违纪等行为问题;3)存在抑郁、体诉问题的VSD男童事件相关电位的异常分别表现为顶叶潜伏期延长、波幅降低及额叶潜伏期延长;4)存在抑郁、强迫、社会退缩、违纪问题的VSD女童事件相关电位的异常分别表现为顶叶潜伏期延长和波幅降低、额叶波幅降低、额叶潜伏期延长、顶叶波幅降低。结论与正常儿童相比,介入治疗后的VSD患儿,学龄期的认知能力存在轻度的损害,且有一定程度的情绪和行为问题,VSD患儿的行为问题与异常的事件相关电位有一定的相关性。     

Experimental determination of latency, severity, and outcome in CNS decompression sickness

Twenty-eight dogs underwent a 300 fsw chamber dive designed to generate spinal cord decompression sickness (DCS), which was detected by observing a reduction in the amplitude of the spinal somatosensory evoked potential (SEP). After an interval of 15 min on the surface following diagnosis, the animals received a therapeutic recompression. The latency was defined as the time between surfacing from the dive and the diagnosis of DCS, the severity as the minimum SEP amplitude, and the outcome as the amplitude of the SEP after 2 h of treatment. Significant correlations between latency and severity (P less than 0.05), latency and outcome (P less than 0.01), and severity and outcome (P less than 0.05) were found. Canine spinal cord latency is shown to be very similar to that found in man up to a surface interval of 30 min. The association between latency, severity, and outcome of spinal cord DCS is discussed with reference to the possible mechanisms involved in this disease.     

Influence of dietary vitamin E deficiency on compression injury of rat spinal cord

The influences of vitamin E deficiency on compression injury of the rat spinal cord associated with ischemia were investigated. Growing rats were divided into two groups and given a diet containing either 2 IU/100 g or less than 0.1 IU/100 g of alpha-tocopherol acetate, respectively, for 6-8 weeks before experiments. Motor disturbances induced by spinal cord injury were found to be enhanced by vitamin E deficiency. The spinal cord blood flow (SCBF) was reduced by compression and subsequently increased transiently and then decreased gradually in both groups, but the level was lower in the vitamin E-deficient group than in the control group. After injury, the vitamin E-deficient group showed lower recoveries than the control group in the amplitude and latency of spinal cord evoked potentials and greater pathological changes of the spinal cord, such as bleeding and edema. The increase in the level of TBA-reactive substances in the spinal cord after injury increased with decrease in the dietary level of vitamin E. These results suggest that vitamin E may have a protective effects against ischemic spinal cord injury by its antioxidant effect.     

42例脊髓髓内室管膜瘤的显微外科治疗与预后分析

目的 探讨脊髓髓内室管膜瘤的手术技术和影响预后的因素.方法 对42例接受显微手术治疗的脊髓髓内室管膜瘤患者进行随访,并采用McCormick临床功能分级对手术前后的状况进行评定.结果 显微外科手术治疗可以显著地改变脊髓的功能状况,预后与年龄、性别、肿瘤长度等均无显著性相关,而与术前的脊髓功能呈显著正相关.结论 显微外科手术能够有效地治疗脊髓髓内室管膜瘤,早期发现、诊断和显微手术治疗是获得良好预后的必然选择.全切肿瘤、术中使用电生理监测、椎板切除术后的椎板重建可以提高手术治疗效果.     

Oxygen in the treatment of spinal cord decompression sickness

Twenty-five anesthetized dogs were used to find the optimum Po2 for the delayed treatment of spinal cord decompression sickness (DCS). They were instrumented for the measurement of physiological variables and somatosensory spinal evoked potentials (SEP) given an air dive of 15 min at 10 bar (300 ft) and decompressed in under 6 min. At the surface SEP were observed for signs of DCS. Fifteen minutes after cord DCS was observed in the SEP, the dogs were compressed to 5.0 bar breathing one of 5 gas mixtures giving a Po2 of 1.0, 1.5, 2.0, 2.5, or 3.0 bar. At the start of therapy all groups were in a similar physiological state with a similar loss of SEP. Between 40 and 120 min, recovery was significantly different (P less than 0.05) between the groups, most SEP recovery having occurred within 15 min. The treatments ended with 22, 32, 70, 66, and 42% recovery, respectively. It would appear that the optimum Po2 is around 2.0 bar.     

Surgical resection as treatment of spinal intramedullary tumors

The authors retrospectively report the results of surgical treatment of spinal cord tumours in the Department of Neurosurgery, University Hospital Utrecht, Holland and review the recent literature. Twenty-eight patients were operated on for an intramedullary spinal cord tumour between 1981 and 1990. The mean follow-up period was 31 months. Neurological evaluation was done using the grading system described by Cooper and Epstein, immediately postoperatively and after 6 months. A total or subtotal resection could be performed in 22 (79%) of the 28 patients. Postoperatively, the neurological function of the legs improved or remained stable in 21 of the 28 patients, and the function of the arms in 26 of the 28 patients. After six months the neurological function in arms and legs had improved or remained stable in 19 of 21 patients. The most frequently occurring tumour, ependymoma, could be radically resected more often (82%) than astrocytoma (33%). Postoperative morbidity is closely related to the level of involvement. Microsurgical exploration at the cervical level is far less dangerous than has always been believed. Surgical mortality was 0%. Radical resection of intramedullary tumours should be attempted and can be achieved with stabilisation or improvement of neurological deficit in the majority of patients.     

无骨折脱位型颈髓损伤的MRI表现及临床意义

目的　探讨无骨折脱位型颈髓损伤的发病机理、MRI表现及临床意义。方法　分析 3 5例无骨折脱位颈髓损伤的 MRI表现。结果　 3 5例共查 MRI 59例次 ,脊髓信号异常 54例次 ,脊髓信号无异常 5例次 ,16例合并颈椎结构退变压迫颈髓 ,11例合并颈椎韧带损伤。结论　 MRI能显示颈髓损伤的范围、受压部位及病理改变 ,为选择正确的治疗方法和手术方式提供可靠依据     

Pressure in the treatment of spinal cord decompression sickness

Previous work had shown that a Po2 of about 2.0 bar was the optimal Po2 for the treatment of spinal cord decompression sickness (DCS). With 20 anesthetized dogs the hypothesis was tested that pressures in excess of a threshold, taken as 3 bar, did not enhance recovery of spinal cord DCS. Dogs were subjected to a 15-min air dive at 10 bar (300 ft) and decompressed over 5.5 min. At the surface, spinal cord evoked potentials (SEP) were observed for changes indicating DCS. Fifteen minutes after DCS was first detected the dogs were recompressed to 3, 5, 7, or 2.8 bar breathing 66, 40, 29, or 100% oxygen which gave a Po2 of 2.0 bar except in the 2.8 bar group. The recovery of the SEP over 2 h was observed. Group mean recoveries at 67, 62, 29, and 42% were not significantly different after 120 min. As the hypothesis was supported, a tentative proposal for changing current therapy was made.     

New method for the intraoperative biochemical monitoring of cerebrospinal fluid in surgery of thoracoabdominal aortic aneurysms

Paraplegia remains to be one of the most dangerous complications following thoracoabdominal aortic surgery with an incidence of 0.5 to 40%. Therefore, intraoperative monitoring of spinal cord function is very important when choosing the appropriate surgical technique. Early detection of spinal cord injury continues to be a crucial problem, moreover, the currently applied electrophysiological methods appear to be inaccurate. The aim of the study was to detect prospective spinal cord injury intraoperatively by monitoring the biochemical parameters of the cerebrospinal fluid (CSF). The authors studied the reversible aerobic/anaerobic metabolic changes by monitoring CSF lactate levels, moreover S-100 protein and neuron-specific enolase (NSE) concentrations--specific for neuroglia and neuronal injury, respectively. One of the important methods to prevent paraplegia is the intraoperative CSF drainage, which may improve spinal cord perfusion. Between 1996-1998 51 patients underwent reconstructive thoracic or thoracoabdominal aortic aneurysm operation. The continuously drained CSF was collected in 10 ml fractions during the preparation, whereas during aortic cross-clamping and de-clamping 10 minute fractions were used. All CSF samples were immediately analysed intraoperatively for pH, pCO2, HCO3, potassium and lactate levels, S-100 protein and NSE were analysed by immunoluminescence. CSF lactate levels increased slightly during aortic clamping and a moderate, but non-significant increase was found in the hyperemic phase (reperfusion) in patients without spinal cord ischemia. Spinal cord injury was detected in 7 cases. These patients exhibited a significant CSF-lactate increase (control vs aortic cross-clamping: 1.9 vs 5.3 mmol/l), moreover CSF-lactate remained elevated throughout the whole operation. Paraplegia did not occur, Tarlov 2 paraparesis developed in four cases and three patients displayed cerebral damage. Intraoperative CSF--especially CSF-lactate--monitoring may help the operating team to detect early anaerobic changes of the metabolism the spinal cord.     

Methyl prednisolone in the treatment of acute spinal cord decompression sickness

Sixteen anesthetized dogs undertook a chamber dive that was designed to induce decompression sickness. Somatosensory evoked potentials (SEP) were used to diagnose and quantify the outcome of spinal cord involvement in the disease. Following diagnosis, 8 animals were treated with methyl prednisolone (MP), 20 mg.kg-1 ("megadose"), as an adjuvant to recompression on an abbreviated U.S. Navy Treatment Table 6. Eight control animals were recompressed in a similar manner, but received the MP diluent only as an adjuvant. Analysis of the SEP at the conclusion of treatment showed that there was no significant difference in outcome for the 2 groups of animals. However, if all the SEP recorded during the treatment period are compared, the MP-treated animals experienced a significantly worse outcome than the diluent-treated controls. The risks and benefit of using corticosteroids in the treatment of human spinal cord DCS are discussed.     

Female sexuality after spinal cord injury

A questionnaire investigating women's perception of sexuality and sexual behavior after spinal cord injury was mailed to all 74 women followed by the Central Pennsylvania Spinal Cord Injury Program. 37% responded. (After spinal cord injury, women rated sex as being 26% less important to them, but also felt 23% less satisfied with their sexual lives.) 52% were able to achieve an orgasm after their injury, but half of the women who experienced orgasm felt it was different after spinal cord injury. The biggest perceived change after spinal cord injury was perceived attractiveness of their bodies. Women rated their bodies as being only half as attractive after their injury as before. Female sexuality remains a vastly underresearched area in spinal cord injury, and much more data is needed to counsel women about sex after their injury. All members of the rehabilitation team need to be comfortable addressing issues of sexuality with their patients.Presented at the American Spinal Injury Association Annual Meeting, Orlando, FL, May 4, 1990.