异氟醚一氧化亚氮和硫喷妥钠麻醉在术中体感诱发电位的监护

研究了５１例志愿全麻手术患者不同麻醉药浓度异氟醚和６６％氧化亚氮及硫喷妥钠（７ｍ／ｋｇ）时对体感诱发电位（ＳＥＰ）的影响。结果表明，随着异氟醚吸入浓度的增高，ＳＥＰ各个波峰潜伏期（Ｐ１、Ｎ１、Ｐ２、Ｎ２）逐渐延长，波幅（Ｐ１－Ｎ１、Ｐ２－Ｎ２）逐渐降低，其中以Ｎ２潜伏期延长最明显（Ｐ＜０．０１），Ｐ２－Ｎ２波幅降低最显著。停止吸入麻醉药后，ＳＥＰ各个波峰潜伏期均开始缩短，波幅逐渐增加；出现角膜反射时，Ｎ２潜伏期已达麻醉前范围（Ｐ＞０．０５）。再次加深麻醉后，ＳＥＰ潜伏期和波幅重现以上变化。提示异氟醚一氧化亚氮麻醉使ＳＥＰ呈剂量依赖效应，麻醉深浅与ＳＥＰ变化呈正相关关系。另外，硫喷妥钠静注１０分钟后，ＳＥＰ潜伏期延长，波幅下降，仍以Ｎ２潜伏期延长和Ｐ２－Ｎ２波幅降低最显著。说明异氟醚一氧化亚氮和硫喷妥钠麻醉中，皮层ＳＥＰ可做为连续监护麻醉深浅的有效方法，而晚成份（Ｎ２潜伏期和Ｐ２－Ｎ２波幅）为麻醉深度的重要指标。     

缺血和再灌流对脊髓血流量及运动诱发电位的影响

本文采用家兔失血性休克模型，使血压下降至３０ｍｍＨｇ维持３０ｍｉｎ后再灌流，让血压回升到正常范围。观察缺血再灌流期 ＳＣＢＦ和 ＳＥＰ变化。缺血期平均动脉压 ３０～４０ｍｍＨｇ，脊髓 Ｔ１２及Ｌｌ节段灰质血流量减少５７％～６４％，白质血流量减少３２％～５０％；ＳＭＥＰ的潜伏期明显延长（Ｐ＜０．００１），各波的波幅降低并有２５％～６７％的波幅消失。再灌流期当血压回升到９０～１３０ｍｍＨｇ时，灰质血流量仍低于伤前（Ｐ＜０．０１），白质血流量无显著差异．ＳＭＥＰ潜伏期仍明显延长（Ｐ＜０．０５），除Ｐｌ波波幅下降有统计意义外，其它各波幅无差异，波幅消失占２５％～３３．３％。光镜下见脊髓存在损伤性病理变化，显示缺血再灌流后脊髓组织仍然存在继发缺血性病理损害和神经功能障碍。     

异氟醚—氧化亚氮和硫喷妥钠麻醉在术中体感诱发电位的监护

研究了５１例志愿全麻手术患者不同麻醉药浓度异氟醚和６６％氧化亚氮及硫喷妥钠（７ｍｇ／ｋｇ）时对体感诱发电位（ＳＥＰ）的影响。结果表明，随着异氟醚及浓度的增高，ＳＥＰ各个波峰潜伏期（Ｐ１，Ｎ１，Ｐ２，Ｎ２）逐渐延长，波幅（Ｐ１－Ｎ１，Ｐ２－Ｎ２）逐渐降低，其中以Ｎ２替伏期延长最明显（Ｐ〈０．０１），Ｐ２－Ｎ２波幅降低温显著。停止吸入麻醉药后，ＳＥＰ各个波峰潜伏期均开始缩短，波幅逐渐增加；出现角膜反射     

神经管闭合不全的手术疗效探讨

对手术治疗的４０例神经管闭合不全患者的神经功能状态做临床评价及胫后神经皮层体感诱发电位（ＣＳＥＰ）测量，发现手术前后神经缺陷的临床评分有显著差异（Ｐ＜０．００２）。行胫后神经ＣＳＥＰ检查的２０例患者，１６例手术后双下肢胫后神经ＣＳＥＰＰ４０峰潜伏期明显缩短（Ｐ＜０．０００５）；另４例手术前５根胫后神经ＣＳＥＰ波形消失而术后恢复（Ｐ＜０．０１）。说明手术是一有效的治疗方法，不仅可阻止神经缺陷的发展，而且使神经缺陷得到改善。     

脊髓损伤皮层体感诱发电位（CSEP）术中监护的实验研究

目的：通过开展皮层体感诱发电位（ＣＳＥＰ）术中监护脊髓损伤的实验研究，以确定脊髓损伤的临界值并有效的评价预后，为临床应用提供依据。方法：２８只中国家犬随机分成４组，用ＡｌｅｎＷＤ法致脊髓轻度、重度和完全性损伤，术中ＣＳＥＰ动态监测，并观察伤后１～３个月脊髓组织学改变、ＣＳＥＰ和功能恢复情况。结果：脊髓损伤ＣＳＥＰ术中监护临界值为，伤后２分钟Ｐ１潜伏期较术前延长不超过１．５倍，波幅下降不超过５０％；伤后１０分钟Ｐ１潜伏期较术前延长不超过１．８倍，波幅下降不得超过５５％。波幅变化灵敏，其恢复早于形态学及功能变化。结论：ＣＳＥＰ术中监护脊髓损伤较准确可靠，并能评价其预后。     

脊柱脊髓手术中皮层体感诱发电位（CSEP）监护的临床研究

目的：通过开展皮层体感诱发电位（ＣＳＥＰ）术中监护脊髓功能的临床研究，有效的预防医原性脊髓损伤，杜绝截瘫的发生。方法：６０例手术患者按Ｆｒａｎｋｅｌ分级术前属Ｂ级１１例，Ｃ级１９例，Ｄ级１２例，Ｅ级１８例，ＣＳＥＰ术中连续动态监测。作者经实验研究并结合临床提出ＣＳＥＰ术中监护临界值为：Ｄ、Ｅ级患者术中波幅较麻醉后下降不超过５０％，潜伏期延长不超过７０％；Ｂ、Ｃ级患者术中波幅较麻醉后下降不超过４０％，潜伏期延长不超过５０％。结果：４５例未达到监护临界值，术后无脊髓损伤。超过临界值发出警告１５例，其中１３例接受警告术后脊髓功能无损害，２例不顾警告继续手术，术后发生完全性截瘫。结论：ＣＳＥＰ术中监护脊髓损伤准确可靠，值得推广应用。     

普鲁卡因对上肢短潜伏期体感诱发电位的影响

目的：探讨静滴普鲁卡因对短潜伏期体感诱发电位（ＳＬＳＥＰ）的影响。方法;对上肢感觉传导无异常的病人１５例,分别观察静脉滴注普鲁卡因前以及滴注１％普鲁卡因２０ｍｇ．ｋｇ＾０－１．ｈ＾－１１０分钟、４０ｍｇ．ｋｇ＾－１、ｈ．＾－１５分钟和６０ｍｇ．ｋｇ＾－１．ｈ＾－１５分钟的上肢ＳＬＳＥＰ,比较Ｎ１４,Ｎ２０,Ｐ２３各波的潜伏期,Ｎ１４－Ｎ２０波间潜伏期（ＣＣＴ）以及Ｎ２０Ｐ－Ｐ２０的峰间值。结果：Ｓ     

体感诱发电位皮层成份在监测脊柱手术中的作用

目的：评价监测体感染诱发电位（ＳＥＰ）Ｎ２０、Ｐ４０波在脊柱手术时的方法及意义。方法：对２２例脊柱手术病人进行上肢或下肢ＳＥＰ监测并进行术后随访。结果：１０例病人的Ｎ２０、Ｐ４０波潜延长大于１ｍｓ,波幅降低大于５０％,３例波形完全消失,但只有１例术后神经症状加重。结论：脊柱手术时仅则上肢或下肢ＳＥＰ皮层成份意义较小,需做多形式监测;判断时除既往异常标准外,需注意ＳＥＰ异常持续的时间及潜伏期无明显变     

咪唑安定对体感诱发电位的影响

目的：了解咪唑安定对体感诱发电位的影响。方法：选择３０例ＡＳＡＩ～Ⅱ级的脑外科手术病人，根据国际１０～２０系统，在Ｃ３或Ｃ４、ＦＰｚ（参考）和ＳＣ（第二颈椎棘突处）安放盘状记录电极，记录体感诱发电位。均分为三组按剂量（０．２ｍｇ／ｋｇ、０．３ｍｇ／ｋｇ和０．４ｍｇ／ｋｇ）静脉注射咪唑安定，连续观察皮层Ｎ２０、Ｐ２３和颈髓Ｎ１４电位的变化。结果：（１）用药后，皮层Ｎ２０和颈髓Ｎ１４电位的波幅降低，分别抑制到术前的６３．７５％和４８．７５％（Ｐ＜０．０５），苏醒后恢复到基础水平；（２）颈髓Ｎ１４、皮层Ｎ２０和Ｐ２３的潜伏期及中枢传导时间均无显著延长，（３）各剂量组间的ＳＥＰ变化无明显差别。结论：咪唑安定对ＳＥＰ一定程度的抑制作用临床意义不足，可用作ＳＥＰ监测时的静脉麻醉药。     

围脑干手术中体感诱发电位与心率监测的比较

目的：研究围脑干手术中体感诱发电位（ＳＥＰ）神经生理监测与ＨＲ监测的关系。方法：选择４３例全凭静脉麻醉的围脑干手术病例,对两侧正中神经分别进行刺激,记录相应ＳＥＰ的Ｎ２０波形,手术Ｎ２０发生明显变化（潜伏期延长超过１ｍｓ）或波辐降低超过５０％）,即通知术者调整操作,ＨＲ出现突然而明显的变化也及时通知术者。结果：３例术后出现神经病损者术中ＳＥＰ均表现为持续抑制,而其中１例ＨＲ并没有明显变化。术中ＳＥ     

Local anesthetic-induced conduction block and nerve fiber injury in streptozotocin-diabetic rats.

Patients with diabetes may have peripheral neuropathy, which may have clinical implications for the use of regional nerve block. The effects of local anesthetics on nerve conduction and nerve fiber injury were tested in control rats and at 4 weeks after the onset of diabetes in rats injected with streptozotocin (50 mg/kg intraperitoneally). Nerve conduction was assessed by recording evoked electrical activity in hindpaw muscles following ipsilateral electrical stimulation of the sciatic nerve near the hip. Block of motor nerve conduction was quantified by recording the amplitude of the evoked response at 1-min intervals for up to 15 min after the injection of 500 microliters 1% lidocaine HCl or procaine HCl into the midthigh next to the sciatic nerve. In control animals, procaine was much less effective than lidocaine in producing conduction block. The rate and magnitude of lidocaine-induced conduction block were not significantly different between control and diabetic groups. However, conduction block due to procaine was sufficiently enhanced in diabetic rats to become comparable to that of lidocaine-treated control nerves. Long-lasting injury was assessed in sciatic nerve harvested 2 days after the extraneural injection of saline or 2 or 4% lidocaine HCl. Using a light microscope with a superimposed grid, nerve edema was quantified as the proportion of intersection points falling on extracellular space. Lidocaine induced edema in both control and diabetic nerves, but 4% lidocaine induced significantly more edema in diabetic nerves than in controls. Nerve fiber injury, based on light microscopic scoring of axonal degeneration and demyelination, was not observed in saline-treated nerves.(ABSTRACT TRUNCATED AT 250 WORDS)     

体感诱发电位检查在先天性脊柱侧凸神经功能评估中的价值

目的 探讨体感诱发电位(SEP)检查在伴脊髓发育畸形的先天性脊柱侧凸(CS)中的诊断价值.方法 回顾性分析2001年9月到2007年9月诊治的187例CS患者临床资料,其中男性85例,女性102例;年龄3～22岁,平均13.8岁.所有患者均行全脊髓磁共振检查判断是否存在脊髓发育畸形.分析术前SEP的峰潜伏期及左、右侧峰潜伏期差值.SEP波形消失、峰潜伏期延长及峰潜伏期不对称定义为SEP异常.比较有无脊髓发育畸形患者的临床特征及SEP异常发生率的差异.结果 共有32例患者伴脊髓发育畸形.CSⅢ型(混合型)伴脊髓发育畸形比例(30.8%)高于Ⅰ型和Ⅱ型(P＜0.05).伴脊髓发育畸形组平均侧凸Cobb角大于无脊髓发育畸形组(P＜0.05),而两组平均后凸Cobb角差异无统计学意义(P＞0.05).伴脊髓发育畸形组SEP异常率与无脊髓发育畸形相比,差异有统计学意义(x2=4.70,P＜0.05).结论 SEP检查可以评估CS患者的神经功能状态,对CS伴脊髓发育畸形具有辅助诊断价值.     

Ultralong-lasting nerve block: triethyldodecyl ammonium bromide is probably a neurotoxin rather than a local anesthetic

The profile and duration of action of triethyldodecyl ammonium bromide (TEA-C12) on natural spike activity of rabbit aortic nerve was examined. To study the profile of action, a segment of the aortic nerve of anesthetized rabbits was placed in a perfusion chamber and exposed to increasing concentrations of TEA-C12 and, for comparison, of procaine. Total nerve activity was recorded continuously and its change related to drug concentrations (concentration/effect curves). The half-lives of onset time after drug administration and recovery following drug-washout were also determined. To study the duration of conduction block induced by TEA-C12, the aortic nerve of anesthetized rabbits was exposed to a concentration slightly higher than the minimal blocking concentration for an average time of 130 min after complete conduction block occurred. Three to 40 days later, the nerves were examined both neurophysiologically and neuropathologically. TEA-C12 blocked nerve activity in a concentration-related manner, as did procaine; however, the onset time (t1/2) was much slower for TEA-C12 (9.2 min) than for procaine (2.2 min). Most importantly, TEA-C12 block could not be reversed within 9 h of drug-washout, whereas all the procaine-blocked nerves completely recovered (t1/2 = 3.0 min). Nerve activity was completely blocked by TEA-C12 and nerve block was accompanied by severe morphological damage with complete loss of myelinated nerve fibers and severe axonal edema of the remaining axons for about 4 weeks. Nerve function completely recovered, but with only partial morphological restoration between day 30 and 40 after the initial block.(ABSTRACT TRUNCATED AT 250 WORDS)     

大鼠颈神经前支受压后肌电及解剖学改变

目的　设计大鼠颈神经前支受压模型并观察大鼠颈神经前支受压后的电镜及肌电改变。方法　Wistar雄性大鼠 ,将直径 1mm的硅胶管作纵形切开 ,于接近背根神经节远端套入颈6神经前支 ,用丝线在硅胶管外轻松地结扎 ,造成神经受压。在神经受压前、受压后 2周及 4周测定肌皮神经的躯体诱发电位 (SEP) ;同时切取受压神经段、对侧正常神经及双侧背根神经节作组织形态学检查。结果　受压后2周、4周肌皮神经SEP的波幅低于受压前 ,其潜伏期比受压前延长 ,两者相比差异有显著性意义 (t =18 7、15 6,P <0 .0 1)。扫描电镜下观察见受压段神经呈纤维变性、神经脱髓鞘及炎症改变。结论　该模型具有切实可行、经济方便、可重复的特点 ,为研究颈神经前支受压的合适模型     

Eeffect of nerve growth factor on changes of myelin basic protein and functional repair of peripheral nerve following sciatic nerve injury in rats

OBJECTIVE: To investigate the therapeutic effect of nerve growth factor (NGF) on changes of myelin basic protein (MBP) and functional repair of sensory and motor nerve following sciatic nerve injury. METHODS: The sciatic nerves of rats were injured by sectioning with shaver,and divided into 3 groups: NGF group (Group A), group of normal saline solution (Group B), untreated group (Group C). The time point of observation was at the 4th week after operation. Sensory evoked potential (SEP) and motor evoked potential (MEP) were detected by Model WD-4000 nerve potential working diagnosis system. Immunohistochemical analysis was used for identification of MBP. RESULTS: The latency of SEP in the Group A at the 4th week after operation was shorter than that in the Group B (P<0.05). The MEP was elicited in 76% of the Group A and was higher than that in the Group B. Results of immunohistochemistry showed that there were less MBP-positive cells in the Group A than in the Group B in one and four weeks respectively. CONCLUSIONS: NGF can improve the conductive function of injured peripheral nerve and facilitate regeneration of nerve.     

Studies of local anesthetic action on natural spike activity in the aortic nerve of cats

The aortic nerve was used to study the blocking action of procaine and bupivacaine on natural spike activity. In anesthetized cats, a segment of the aortic nerve was placed in a perfusion chamber and exposed to increasing drug concentrations, varying pH, while temperature remained constant. Total nerve activity was recorded continuously, and its change was related to drug concentration. The half-time of recovery following drug wash-out was also determined. At pH 7.4, the minimal blocking concentration was 0.5 X 10(-3) mol/l for procaine and 0.05 X 10(-3) mol/l for bupivacaine, the half-times of recovery 1.4 and 3.0 min, respectively. Procaine and bupivacaine reversibly blocked natural spike activity at the same concentrations as they blocked electrically evoked activity. The aortic nerve, whose physiologic spike traffic can be followed continuously for hours, may be used to advantage for studying the long-term effects of local anesthetics in vivo.     

Implantation of sensory nerve into flap: an experimental study and clinical application]

Experimental implantation of sensory nerve into flaps was done, with the purpose of restoration of sensation of the flaps. A scanty amount of nerve endings were found in the vicinity of the implantation after 2 months, obvious regeneration was observed after 3 months, and never endings similar to normal after 4 months. Sensory nerve was implanted into flaps in the hands and feet of 25 patients. 1-2 year follow-up showed that pain, temperature and tactile sensations recovered to normal, and two-point discrimination was 11-22 mm in the hands and 35-40 mm in the feet. In 3 patients, the implanted nerves were blocked with procaine, and anesthesia of the flaps ensued, thus it was proved that the flaps were innervated by the implanted sensory nerves.     

蛇毒神经生长因子对大鼠坐骨神经损伤功能修复的时效作用研究

目的 :研究蛇毒神经生长因子 (SNGF)对大鼠坐骨神经损伤修复的时效作用。方法 :建立大鼠坐骨神经钳夹模型 ,局部滴加药物和术后肌注 90 0Bu/kg的SNGF ,分别给药 14、2 1和 2 8d。通过展爪反射、趾间距、脊髓诱发电位(SEP)、运动诱发电位 (MEP)观察 ,评定蛇毒神经生长因子对大鼠坐骨神经损伤修复的时效作用。结果 :蛇毒NGF以90 0Bu/kg剂量 ,每天于伤侧肌肉注射一次 ,分别给药 14、2 1、2 8d均有促进伤侧神经功能恢复的作用 ,且具有一定的时效关系 ,给药 2 1、2 8d组治疗效果较给药 14d组效果好 (P <0 .0 5 )。 2 1d组与 2 8d组间无明显差别。结论 :SNGF对大鼠坐骨神经损伤的修复作用具有一定的时效作用。     

Evoked potentials in the investigation of traumatic lesions of the peripheral nerve and the brachial plexus

Nerve conduction studies using nerve action potential (NAP), sensory nerve action potential (SNAP), evoked muscle action potential (M-response), retrograde conduction in the motor axon (F-response), and cortical and subcortical somatosensory evoked potential (SEP) are useful tools for evaluation of the peripheral nervous system. SEP recording has the advantages of being applicable to severely damaged nerves because of its amplification mechanism and of disclosing proximal root lesions that would not be disclosed by other methods. When SEP recording is used in an operating theater, the amplification mechanism is suppressed by the effect of the anesthetic. Nevertheless, it is valuable for evaluating proximal root lesions in conjunction with NAP recording and M-response. Strong M-response of the serratus anterior and paraspinal muscles is a most encouraging finding if nerve repair is performed more than seven days after brachial plexus injury. SEP recording can clarify the functional continuity of the spinal root to the spinal cord. Thus the presence of SEPs becomes an important positive finding and implies the potential of nerve repair even when an M-response is not provoked by a situation such as prolonged conduction block.     

Clinical evoked potential research on the regeneration process in peripheral nerve injury

The examining results of SNAP, MAP and SEP of 239 median nerves and 76 ulnar nerves injuries are reported. Among those patients whose curative effects of complete severed nerves have reached "good" or above, SEP could be evoked in third month after suturing, MAP began to appear in sixth month and could be monitored in almost all patients in tenth month. On the other hand, SNAP was more difficult to evoke, only 2 cases could be recorded in tenth month, the figure came to about 80% after 4 years, and it could not be recorded in a few patients even after 10 years. While the clinical curative effects changed, the recovery rate of evoked potential changed accordingly. It has been proved the examination of evoked potential has important reference value to the diagnosis, treatment, regeneration and prognosis evaluation of peripheral nerve injury.