Definition of the safe lower limits of aortic resection during surgical procedures on the thoracoabdominal aorta: use of somatosensory evoked potentials.
Definition of the safe lower limits of aortic resection during surgical procedures on the thoracoabdominal aorta: use of somatosensory evoked potentials.
复制标题
胸腹主动脉手术过程中主动脉切除安全下限的定义：体感诱发电位的使用。
DOI：
10.1016/s0735-1097(83)80246-0
复制
发表时间：
1983
影响因子：
24
通讯作者：
F. Spencer
中科院分区：
文献类型：
--
作者：
J. Laschinger;J. Cunningham;O. Isom;I. Nathan;F. Spencer
将术中体感诱发电位监测技术应用于犬脊髓缺血模型，试图确定胸主动脉手术中主动脉切除的安全下限。15只动物接受左胸廓切开术，建立部分左心房/股动脉旁路，以维持近端降主动脉阻断后的远端主动脉灌注。在第I组动物（n = 6，对照组）中，未进行进一步干预，因此可以通过测量脊髓血流量和体感诱发电位来评估排除对脊髓血供不重要的血管的效果。在第II组动物（n = 8）中，远端主动脉阻断水平逐渐降低，直至发生体感诱发电位丧失（关键血管阻断）。然后评估关键血管阻断对脊髓血流量的影响。阻断对脊髓血供非关键的多条血管（组I）对脊髓血流量或功能（体感诱发电位）没有影响。排除对脊髓血液供应至关重要的血管导致显著的脊髓缺血（83.4%流量减少，概率[p] < 0.05，与基线相比）和缺血性脊髓功能障碍（体感诱发电位丧失）。这些数据表明，术中体感诱发电位监测允许识别脊髓缺血，由于排除的血管对脊髓血液供应至关重要，因此，是一个准确的预测的安全下限的主动脉切除术在胸降主动脉或胸腹主动脉，或两者的外科手术。
The technique of intraoperative monitoring of somatosensory evoked potentials was applied to a canine model of spinal cord ischemia in an attempt to determine the safe lower limits of aortic resection during thoracic aortic surgery. Fifteen animals underwent left thoracotomy with institution of partial left atrial/femoral artery bypass for maintenance of distal aortic perfusion after proximal descending thoracic aortic exclusion. In Group I animals (n = 6, control), no further interventions were performed so that the effect of exclusion of vessels noncritical to spinal cord blood supply could be assessed by measurements of spinal cord blood flow and somatosensory evoked potentials. In Group II animals (n = 8), the level of distal aortic exclusion was progressively lowered until loss of somatosensory evoked potential (critical vessel exclusion) occurred. The effect of critical vessel exclusion on spinal cord blood flow was then assessed.Exclusion of multiple vessels noncritical to spinal cord blood supply (Group I) had no effect on spinal cord blood flow or function (somatosensory evoked potentials). Exclusion of vessels critical to spinal cord blood supply resulted in significant spinal cord ischemia (83.4% flow reduction, probability [p] < 0.05 versus baseline) and ischemic spinal cord dysfunction (loss of somatosensory evoked potential). The data indicate that monitoring of intraoperative somatosensory evoked potentials allows recognition of spinal cord ischemia due to exclusion of vessels critical to spinal cord blood supply and, thus, is an accurate predictor of the safe lower limits of aortic resection performed during surgical procedures on the descending thoracic or the thoracoabdominal aorta, or both.