间断鞘内注射罗哌卡因和布比卡因对大鼠后肢感觉、运动功能的影响

目的 探讨间断鞘内注射不同浓度罗哌卡因、布比卡因后大鼠后肢感觉、运动功能及脊髓背根神经细胞的变化.方法 SD大鼠30只,采用随机数字表法分为5组(n=6).按改良法于L3-4蛛网膜下腔置管.分别经导管注入0.75%罗哌卡因(R1组)、1%罗哌卡因(R2组)、2%罗哌卡因(R3组)和2%布比卡因(B组)40μL,对照组(N组)注入人工脑脊液40μL,每1.5小时一次,共3次.于注药后1 d开始对5组大鼠进行热板仪、压痛仪及后肢撑力实验.以评价5组大鼠的感觉、运动功能.结果 N、R1、R2组感觉、运动功能及脊髓背根神经节病理学结果基本正常;R3组出现暂时性感觉异常,且神经元有轻度改变;B组出现暂时性肌力下降和不可逆性感觉异常,神经元表现为空泡形成、变性.结论 大鼠蛛网膜下腔间断注射浓度低于2%的罗哌卡因对脊神经无永久性损伤.而注射2%罗哌卡因和2%布比卡因均可造成大鼠后肢神经毒性损伤.且后者损伤程度大于前者.     

罗哌卡因和布比卡因蛛网膜下腔-硬膜外联合阻滞的临床观察

目的 比较相同剂量的罗哌卡因、布比卡因蛛网膜下腔-硬膜外联合阻滞用于经腹子宫全切手术的临床效果及安全性.方法 选择拟行子宫全切病人80例,随机双盲均分为2组.罗哌卡因组(R组):0.75%罗哌卡因2ml+10%葡萄糖1ml;布比卡因组(B组):0.75%布比卡因2ml+10%葡萄糖1ml.观察各组感觉、运动阻滞的起效和恢复时间、麻醉效果及围手术期不良反应.结果 R组比B组感觉及运动阻滞起效慢(P＜0.05),维持时间短(P＜0.05),下肢运动阻滞程度R组显著低于B组(P＜0.05).R组比B组活动更早(P＜0.05).血压下降发生率R组明显低于B组(P＜0.05).结论 等剂量的罗哌卡因和布比卡因蛛网膜下腔-硬膜外联合阻滞用于经腹子宫全切手术可提供安全可靠的麻醉效果,与布比卡因相比,罗哌卡因低血压发生率低,对下肢运动阻滞弱且恢复迅速,有利于病人的及早康复.     

罗哌卡因复合舒芬太尼在臂丛神经阻滞中的应用效果

目的探讨臂丛神经阻滞中罗哌卡因复合舒芬太尼的应用效果。方法我院2015-07-2016-04诊治的行臂丛神经阻滞的手术患者64例为研究对象,依照随机抽签方法分组,研究组(n=32)应用罗哌卡因复合舒芬太尼麻醉,对照组(n=32)采取罗哌卡因联合氯化钠注射液麻醉,对比2组镇痛效果、神经阻滞优良率及不良反应发生率。结果 (1)研究组神经阻滞后30min的VAS评分(0.04±0.00)分,神经阻滞优良率96.9%;对照组神经阻滞后30 min的VAS评分(1.36±0.15)分,神经阻滞优良率71.9%;2组神经阻滞后30min的VAS评分和神经阻滞优良率对比差异均有统计学意义(P0.01);(2)2组不良反应发生率对比差异无统计学意义(P0.05)。结论臂丛神经阻滞中罗哌卡因复合舒芬太尼的应用效果确切,可减轻患者术中疼痛感,提升其神经阻滞优良率,且无明显不良反应,值得借鉴。     

右美托咪啶复合罗哌卡因对神经刺激仪引导下臂丛神经阻滞效果的影响

目的：探讨右美托咪啶复合罗哌卡因对神经刺激仪引导下臂丛神经阻滞效果的影响。方法ASA分级Ⅰ～Ⅱ级的臂丛神经阻滞下行前臂或手部手术患者50例随机分为2组,在神经刺激仪引导下穿刺成功后,A组予以1ug／kg右美托咪啶复合0.5％罗哌卡因26mL,B组予以单纯罗哌卡因26mL。观察两组感觉神经和运动神经阻滞的起效、持续时间;观察麻醉后不良事件发生情况。结果A组感觉及运动神经阻滞的起效时间、持续时间等均优于B组（P＜0.05）,但A组心动过缓发生率高于B组（P＜0.05）。结论右美托咪啶复合罗哌卡因可安全有效地应用于臂丛神经阻滞,且起效迅速、持久,镇静作用良好,但须注意发生心动过缓。     

超声引导定位下腋路臂丛神经阻滞不同剂量利多卡因复合罗哌卡因剂量的使用研究

目的分析超声引导定位下腋路臂丛神经阻滞利多卡因复合罗哌卡因剂量的使用情况。方法选取2016-02—12新疆维吾尔自治区第二济困医院收治的择期行上肢手术98例患者为观察对象,随机分为A、B、C3组,A组、B组各33例,C组32例。3组患者使用相同的麻醉药(2%利多卡因复合0.75%罗哌卡因)。A、B、C 3组麻醉药使用总剂量分别为20、25、30mL。记录3组患者各神经(桡神经、正中神经、尺神经、肌皮神经)感觉组织起效时间、麻醉持续时间和阻滞效果,评价不同剂量利多卡因复合罗哌卡因在腋路臂丛神经阻滞麻醉中的效果,观察3组患者有无麻醉不良反应的发生。结果 A组各神经麻醉起效时间均长于B、C 2组(P0.05),且阻滞效果低于B、C 2组(P0.05);A组麻醉持续时间均短于B、C 2组(P0.05);A、B、C 3组麻醉优良率分别为75.8%(25/33)、97.0%(32/33)和100.0%(32/32),A组麻醉优良率明显低于B、C 2组(P0.05)。3组患者均未出现麻醉相关不良反应。结论 30mL 2%利多卡因复合0.75%罗哌卡因在超声引导定位下腋路臂丛神经阻滞麻醉中具有较高的应用效果,见效快、持续时间长且安全性高,能够提高手术麻醉效果,是一种理想的麻醉方案。     

浓度不同的罗哌卡因在腰丛联合坐骨神经阻滞中的应用效果分析

目的分析浓度不同的罗哌卡因用于PNS(外周神经刺激器)引导下的腰丛联合坐骨神经阻滞的临床效果。方法选取拟行单测下肢的手术患者80例,随机分成A、B、C、D 4组,每组20例。用外周神经刺激器定位,采用经典的后路腰丛与坐骨神经穿刺,给予罗哌卡因的浓度分别为:0.30%、0.375%、0.45%、0.50%,容量均为50mL(腰丛给予30mL,坐骨神经给予20mL),给药后分别测定腰丛-坐骨神经阻滞的感觉阻滞范围、感觉阻滞起效时间、运动阻滞的程度和麻醉阻滞成功率。结果 B、C、D组对股外侧的皮神经和闭孔神经阻滞率高于A组,差异有统计学意义(P0.05);A组的运动阻滞的程度与麻醉阻滞成功率均低于B、C、D组,且A组的感觉起效起效时间较慢(P0.05);B、C、D组间比较无统计学意义(P0.05)。结论 0.375%的罗哌卡因在腰丛联合坐骨神经阻滞中,阻滞效果满意,能够减少局麻药物的用量。     

不同剂量罗哌卡因在鞍麻中的应用

罗哌卡因做为一种新型的长效酰胺类局麻药,以其较低浓度可有效阻滞感觉神经传递、阻滞时程长、感觉与运动阻滞分离以及安全性好等优点已成为临床麻醉常用药[1].鞍麻时仅骶尾神经阻滞,对全身影响较小,且肛门括约肌松弛效果较好,故广泛用于肛门、会阴部手术[1-2].本研究旨在比较不同剂量罗哌卡因在鞍麻中的临床效果和相关并发症.     

0畅2％罗哌卡因用于神经刺激仪引导下股神经阻滞的半数有效剂量

目的：确定0.2％罗哌卡因用于神经刺激仪引导下股神经阻滞的半数有效剂量。方法纳入拟在全麻下行全膝关节置换术患者25例，年龄62～78岁，体质量55～89 kg。ASAⅠ或Ⅱ级，在神经刺激仪引导下行患侧股神经阻滞，定位成功后注入0.2％罗哌卡因。采用Dixon序贯法进行试验，初始剂量为20 mL ，阻滞完全则下1例容量减少2 mL ，阻滞不全则增加2 mL。采用Probit概率单位回归法计算0.2％罗哌卡因神经刺激仪引导下股神经阻滞的半数有效剂量及其95％可信区间（95％ C I）。结果0.2％罗哌卡因神经刺激仪引导下股神经阻滞的半数有效剂量及其95％可信区间为15.1（13.4～16.7） mL。结论0.2％罗哌卡因神经刺激仪引导下行股神经阻滞的半数有效剂量为15.1 m L。     

罗哌卡因注射液用于阴部神经麻醉对分娩镇痛效果分析

目的探讨罗哌卡因注射液用于会阴侧切缝合术的镇痛效果。方法选择在我院分娩时行会阴侧切缝合术的产妇290例,随机分为实验组155例,对照组135例,2组均在双侧阴部神经阻滞麻醉和局部浸润麻醉后行会阴侧切缝合术,试验组用0.5%的罗哌卡因注射液20mL进行麻醉,对照组用1%的盐酸利多卡因20mL进行麻醉。对比缝合中及用药后6个不同时段疼痛强度、麻醉起效时间、第二产程时间、缝合所用时间、新生儿Apgar’s评分、低血压及产后尿潴留等不良反应。结果试验组在不同时段的疼痛强度、麻醉起效时间、第二产程时间、缝合所用时间均低于对照组,差异有统计学意义(P<0.01)。新生儿Apgar’s评分、产后出血、低血压及产后尿潴留的发生无差异(P>0.05)。结论用罗哌卡因注射液进行双侧阴部神经阻滞麻醉和局部浸润麻醉,具有强而持久的镇痛效果,可促进产程进展并有效减轻会阴侧切缝合术后的痛苦,对母婴安全,值得推广。     

老年髋关节置换与腰麻复合腰丛阻滞麻醉

目的：探讨等比重腰麻复合腰丛麻醉在老年髋关节手术中的应用。 方法：以“腰麻,髋关节置换”为中文关键词,检索2000-01/2010-03相关文章。纳入与腰麻与髋关节置换相关研究文献;排除重复研究。以11篇文献为主重点进行讨论。并选择择期行髋关节置换患者50例作为临床验证。采用等比重腰麻复合腰丛麻醉,维持患者侧卧位至术毕,观察麻醉前及麻醉后5,15,30 min的血流动力学变化及心率的变化,观察两侧痛觉阻滞平面,温度觉及触觉平面,Bromage 运动阻滞评分,术中不良反应,患肢有效的镇痛时间及有效的阻滞时间。 结果：目前老年髋关节置换常用的麻醉方法有罗哌卡因单侧腰麻-硬膜外联合麻醉,左旋布比卡因复合舒芬太尼腰硬联合麻醉,连续硬膜外阻滞联合小剂量布比卡因腰麻等方法,研究表明联合麻醉效果好于单纯用药。经临床验证结果,采用等比重腰麻复合腰丛麻醉,麻醉后各时间的血流动力学及心率的变化与麻醉前比较差异无显著性意义。患侧痛觉阻滞平面,温度觉及触觉阻滞平面,Bormage 运动阻滞评分与健侧比较差异有显著性意义(P < 0.01)。术中呕吐1例,低血压6例,患肢的有效镇痛时间及有效阻滞时间分别为(5.5±2.2) h和(2.5±0.5) h。 结论：等比重腰麻复合腰丛麻醉在老年髋关节置换术中的应用是安全可靠的,对全身生理干扰小的麻醉方法。     

置入内固定装置轻度持续性牵张对兔脊髓的潜在损伤

背景：文献报道对脊髓进行不同程度的一过性牵张能造成脊髓不同程度的损伤，但牵张持续性存在时，对脊髓组织造成的影响尚不清楚。 目的：安装内固定对兔脊髓进行轻度持续性牵张，观察其对兔脊髓过氧化物歧化酶活性和丙二醛改变的影响。 方法：36只健康大白兔随机分为3组：假手术组：仅安装内固定不进行撑开；实验组：牵张动物L1/L2节段达本节段小关节突关节面横径的25%并安装内固定维持牵张；对照组：仅给予同等条件饲养；干预后3，7，14 d评价运动功能，并对丙二醛、过氧化物歧化酶做定量分析、组织形态观察脊髓损伤情况。 结果与结论：36只大耳白兔均进入结果分析。实验组及假手术组干预后运动功能有少许下降；在7 d时运动功能可见恢复，14 d时恢复至干预前水平，两组动物运动功能下降程度在同时段组间比较差异无显著性意义；干预后8 d开始，各组动物运动功能与干预前无明显差异。脊髓组织中过氧化物歧化酶活力下降而丙二醛含量增加；实验组在3 d时可见神经元间隙稍增大，尼氏小体减少，偶见神经元萎缩，无明显其他病理改变。其余两组病理切片未见异常。     

兔正中神经F波对脊髓压迫损伤的评估

目的探讨正中神经F波对兔急性椎管狭窄导致脊髓压迫损伤的评估作用及对运动功能的预测价值。方法20只新西兰大白兔用随机分组法分实验组(n=15)和对照组(n=5),实验组分为A、B和C三个亚组(n=5),分别在C6-C7椎板间隙向尾端方向植入直径为1.0 mm、1.5 mm和2.0 mm的实心硅胶柱,分别记录术前和术后波形平稳后的F波,麻醉前和术后2 d进行运动功能评分。对照组用于排除麻醉和手术对F波的影响。结果A、B和C组F波波幅和潜伏期均对椎管狭窄脊髓压迫损伤敏感,分别经过(0.36±0.17)min、(0.36±0.22)min和(0.32±0.13)min波变平稳;A、B和C组术后波形平稳后波幅与基线波幅百分比(71.93%±6.90%)、(34.74%±6.05%)和(8.32%±4.25%)经配对t检验,与本组术前基线波幅与基线波幅百分比(100.00%±0.00%)、(100.00%±0.00%)和(100.00%±0.00%)比较,差异有统计学意义(均P<0.05);A、B和C组手术后波形平稳后潜伏期(9.48±1.31)ms、(12.04±0.48)ms和(10.55±0.21)ms经配对t检验,与术前(8.48±0.76)ms、(9.08±0.91)ms和(8.45±0.71)ms比较,差异有统计学意义(均P<0.05);各组F波术后早期的波幅变化和术后2 d前肢运动功能评分经Spearman相关性分析呈显著性正相关(r=0.960,P<0.05)。结论兔正中神经F波对发现椎管狭窄引起的脊髓损伤非常敏感;早期F波的波幅变化可以预测脊髓损伤后的肢体运动功能。     

Experimental syringomyelia in rabbits and rats after localized spinal arachnoiditis]

In order to produce syringomyelia, localized arachnoiditis was created in adult New Zealand albino rabbits and Wistar rats by the injection of kaolin into the thoracic spinal subarachnoid space and incision of the dura mater of the thoracic spinal cord. The rabbits and rats were divided into 3 groups; the control group, dural incision group (DG) and kaolin injection group (KG). Each rabbit was sacrificed at 4, 8, 12 and 16 weeks after the operation. Each rat was sacrificed at 8 and 16 weeks after the operation. Cavity formation in the cord of all rabbits was examined by ultrasound. All animals were perfused with 10% neutral beffered formalin at 150 cm H2O pressure, and histological examination was performed with Luxol fast blue (LFB) and hematoxylin and eosin (H&E) stains. Results obtained: (1) Cavity formation was noted in 6 of 16 DG of rabbit (37.5%), 5 of 16 KG of rabbit (31.2%) and 2 of 9 KG of rat (22.2%) with histological verification. With use of ultrasound, cavity was noted in 3 of 16 DG rabbits (12.5%) and 2 of 16 KG rabbits (18.8%). (2) Cavity formation was present in the cord adjacent to the marked adhesive arachnoiditis both in rabbits and in rats. (3) Cavity was noted in the ischemic area. (4) In 2 rabbits in which kaolin encircled whole surface of the spinal cord, hydromyelia was formed communicating with enlarged central canal caudad from the kaolin subarachnoid block. (5) Histological examination showed obliteration or narrowing of lumen of the small pial vessels involved in the adhesive arachnoiditis. In the cord parenchyma adjacent to the arachnoiditis, multiple spots of demyelination due secondary to ischemia demonstrated by LFB stain were noted. On the other hand, in the cord with the pia-arachnoid remained uninvolved, no demyelination was observed. (6) Localized adhesive arachnoiditis consisted of proliferation of fibrous tissue, lymphocytic infiltration and obliterating processes of small pial vessels involved in it. These data suggest that the cavitation within the cord would be induced by the ischemia, and hydromyelia would be produced by the pressure dissociation between the spinal subarachnoid space and the central canal.     

Sensitivity and specificity of in vivo diffusion-weighted MRI in acute spinal cord injury

The aim of this study was to test the sensitivity and specificity of diffusion-weighted MRI for the detection of acute spinal cord injury. Forty female New Zealand white rabbits were randomly divided into four groups: the mild, moderate and severe injury groups, and the control (sham operation) group. Contusion of the spinal cord was induced using a weight-drop impactor. All animals were imaged using T1-weighted, T2-weighted, and diffusion-weighted imaging (DWI) sequences at 30 minutes, 6 hours, and 24 hours after injury. One animal from each group was killed at each time point for histologic examination of the spinal cord. DWI had a sensitivity of 100% at all time points, whereas T2-weighted MRI had a sensitivity of 43.33% at 30 minutes after injury, 81.48% at 6 hours after injury, and 95.83% at 24 hours after injury. Conversely, the specificity of DWI was lower than that of T2-weighted MRI at all time points. One animal in the control group had a non-specific high signal on DWI. Significant systematic differences were seen between DWI and T2-weighted MRI at both 30 minutes and 6 hours after injury. The apparent diffusion coefficient values of the lesion were lower than those of adjacent unaffected regions in the mild and moderate injury groups, but higher than adjacent unaffected regions in the severe injury group. The histological findings were reliably correlated with the magnetic resonance findings. We found that DWI has a higher sensitivity, but a lower specificity, than conventional MRI for the detection of early pathological changes after contusive injury.     

Neuroprotective effects of adipose-derived stem cells against ischemic neuronal damage in the rabbit spinal cord

Transplantation of adipose-derived stem cells (ASCs) is one of the possible therapeutic tools for ischemic damage. In this study, we observed the effects of ASCs against ischemic damage in the ventral horn of L(5-6) levels in the rabbit spinal cord. ASCs were isolated from rabbits, and cell type was confirmed by flow cytometry analysis, labeling with CM-DiI dye and differentiation into adipocytes in adipogenesis differentiation medium. ASCs were administered intrathecally into recipient rabbits (2 × 10?) immediately after reperfusion following a 15-min aortic artery occlusion in the subrenal region. Transplantation of ASCs significantly improved functions of the hindlimb and morphology of the ventral horn of spinal cord although CM-DiI-labeled ASCs were not observed in the spinal cord parenchyma. In addition, transplantation of ASCs significantly increased brain-derived neurotrophic factor (BDNF) levels at 72h after ischemia/reperfusion. These results suggest that transplantation of ASCs prevents motor neurons from spinal ischemic damage and reactive gliosis by increasing neurotrophic factors such as BDNF in the spinal cord.     

脊髓缺血再灌注损伤时血清及脊髓组织一氧化氮水平的动态变化及意义

目的 观察一氧化氮(NO)在脊髓缺血再灌注损伤(SCIRI)时血清及脊髓组织中的变化,探讨其在SCIRI中的意义. 方法 采用Zivin法建立家兔SCIRI模型,动态观察NO在血清和脊髓组织中的表达. 结果 血清NO在缺血再灌注(IRI)组缺血末期明显上升,IRI后2 h达到峰值,与缺血前比较差异有统计学意义(P<0.05),IRI后6 h、12 h明显降低,与缺血前及Sham组比较差异有统计学意义(P<0.05);脊髓组织中NO在缺血末期明显升高并达到峰值,缺血再灌注后2h、6 h逐渐下降,与Sham组比较差异有统计学意义(P<0.05),缺血再灌注后12 h下降到Sham组水平. 结论 NO在SCIRI后血清和脊髓组织中表达增高,可能在SCIRI病理过程神经元损伤与修复中发挥一定作用.     

Effects of intrathecal administration of a cell permeant caspase inhibitor,boc-D-fluoromethylketone (BDFMK), on behavioral deficits following spinal cord ischemia: a dose-response analysis

Caspase inhibition has been proposed as a target to attenuate ischemia-induced neurodegeneration and behavioral dysfunction. The present study evaluated the pharmacological effects of a single dose of an irreversible cell permeant general (nonselective) caspase inhibitor, Boc-D-fluoromethylketone (BDFMK) administered intrathecally (i.t.) in a reversible spinal cord ischemia model (RSCIM). Quantal analysis indicated that the P(50) (represents the duration of ischemia that produces permanent paraplegia in 50% of the animals in a group) of the control group was 25.08+/-4.71 min. Using the RSCIM, neuroprotection is observed if a drug significantly prolongs the P(50) compared to the control group. The P(50) values for the BDFMK-treated groups were 27.21+/-2.62, 27.28+/-3.29 and 28.98+/-2.32 min, for the three dose groups studied. There were no statistically significant changes when measured 18 or 48 h following ischemia. Biochemical analysis of cell extracts from the caudal lumbar spinal cord indicated that there was increased production of the 120-kDa fragment of fodrin suggesting enhanced caspase-3 activity, an increase that was reduced by i.t. BDFMK administration. Moreover, in caudal lumbar spinal cord extracts from a set of paraplegic rabbits (25-50 min occlusion), we measured a 32-42% decrease of caspase-3 activity in BDFMK-treated rabbits. The present study shows that i.t. administration of BDFMK reduced caspase-3 activity, but the inhibition did not translate into a significant behavioral improvement. Our results suggest that administration of a single dose of the caspase inhibitor BDFMK is insufficient to attenuate ischemia-induced behavioral deficits following aortic occlusion.     

Vulnerability of the spinal cord to injury from extracorporeal shock waves in rabbits.

We studied the vulnerability of the spinal cord to extracorporeal shock wave treatment (ESWT). In this experiment, 12 rabbits were divided into three groups (4 in each group). All animals underwent a preceding lumbar laminectomy at L4 1 week before ESWT. In group 1, 2000 impulses of high dose (0.62 mJ/mm2 energy flux density) shockwave energy were applied to the spinal cord at the laminectomy site. In group 2, 2000 impulses of low dose (0.18 mJ/mm2 energy flux density) shockwave energy were applied to the same site as group 1. Group 3 did not receive ESWT and served as a control. None of the rabbits in the study groups (groups 1 and 2) showed weakness or paralysis of the hind limbs throughout the entire post-ESWT period. The spinal cord at the L4 level of all animals was harvested on day 13 after laminectomy. On gross morphology, the cord from the study groups and the control group showed normal surface appearance. On microscopic examination, the cord from the control group was normal, whereas the cords from the study groups showed varying degrees of myelin damage and neuronal loss. These microscopic findings were dose-dependent. For the low-energy group (group 2), neuronal loss was insignificant compared to that in the control group. ESWT produced varying degrees of microscopic changes of the treated cords, but no neurological symptoms. The neuronal injury was dose-dependent and mild in the low-energy group.     

经颅电刺激运动诱发电位术中监测预防脊髓缺血性损伤的实验研究

目的探讨术中经颅电刺激运动诱发电位(TceMEP)监测在脊髓髓内肿瘤切除术中对脊髓缺血性损伤的保护作用。方法将16只实验兔随机分为4组,4只/组;对照组用来确定TceMEP的最佳刺激强度,术前连续记录3h(30min/次),并于术中、术后不同时间点记录以排除麻醉、手术对诱发电位的影响;另3组分别结扎3、4、5根腰动脉,血管结扎后5min内记录TceMEP,并行运动功能评分,2d后取标本行苏木精-伊红染色。结果TceMEP波幅对缺血性脊髓损伤敏感;血管结扎后,可见波幅先降低后逐渐恢复,5min内均趋于稳定。TceMEP波幅变化与麻醉清醒后运动功能、结扎2d后运动功能和病理损伤程度均呈正相关,r分别为0.977、0.933、0.971,差异均有统计学意义(P0.01)。结论术中TceMEP可敏感地反映缺血性脊髓损伤,可在脊髓缺血可逆期内发现缺血性损伤,有助于及时采取措施,预防不可逆性脊髓损伤的发生。     

兔脊髓损伤后脊髓运动诱发电位D波与后肢运动功能的关系

目的 探讨兔脊髓损伤模型损伤后双后肢肌力和脊髓运动诱发电位D波之间的关系.方法 45只兔按随机数字表法分为打击组(显露硬脊膜并打击,并按打击能量大小分为50gcf组、75 gcf组、100gcf组、125 gcf组、150gcf组、175 gcf组、200 gcf组、250 gcf组)和对照组(显露硬脊膜但不打击).打击后和第4周末记录兔双后肢肌力、运动诱发电位D波的潜伏期和波幅,并在第4周末取家兔脊髓行神经微丝(NF)免疫组化染色及病理形态观察,测量NF吸光度值.结果 脊髓损伤当时和第4周末脊髓硬膜外运动诱发电位D波波幅下降的幅度与兔后肢运动功能呈线性相关关系(R2=0.98,P＜0.001,回归曲线Y=0.33+4.82X;R2=0.99,P＜0.001,回归曲线Y=0.04+0.51X),而D波潜伏期的变化则与术后肌力的变化无相关关系(R2=-0097,P=0.573;R2=-0.165,P=0.337);NF吸光度值随着D波波幅的下降而下降,两者呈线性相关关系(R2=0.87,P＜0.001,回归曲线Y=0.12+0.58X).结论 在脊髓损伤中可以通过脊髓硬膜外运动诱发电位D波波幅的下降程度作为判断脊髓损伤运动功能障碍程度的指标.

Abstract：

Objective To study the relationship between D-wave of thc spinal motor evoked potential and hindlimb motor function status (myodynamia) of rabbits with experimental spinal cord injury. Methods Forty-five rabbits were randomly divided into a control group and 8 injured groups (receiving Allen's injury of50, 75, 100, 125, 150, 175, 200 and 250 gcf, respectively). The myodynamia of hindlimbs and the latency and amplitude of D-wave of the spinal motor evoked potential were recorded right after the injury and in the 4th week of injury, respectively. Simultaneously in the 4th week of injury,the rabbits' spinal sections were stained with neurofilament (NF) immunohistochemistry and their pathological morphologies were observed; and optical densities of NF were measured. Statistic analysis of correlation between myodynamia of hindlimbs and latency and amplitude of D-wave was performed.Results A statistic linear correlation was found between amplitudes declination of D-wave of the spinal motor evoked potential and modified Tarlov's scores right after the injury and in the 4th week of injury (R2=0.98, P＜0.00, regression curve: Y=0.33+4.82X; R=0.99, P＜0.001, regression curve: Y=0.04+0.5 1X),but no statistical correlation was noted between myodynamia and the latency of D-wave of the spinal motor evoked potential at the same time periods(R2=-0.097, P=0.573; R2=-0.165, P=0.337). And the optical density of NF decreased following the amplitude declination of D-wave of the spinal motor evoked potential with linear correlation (R2=0.87, P＜0.001, regression curve: Y= 0.12+0.58X).Conclusion Amplitude declination of D-wave of the spinal motor evoked potential could be used to evaluate the severity of dyskinesia in the injured spinal cord.