The reliability of evoked spinal cord potentials elicited by direct stimulation of the cord as a monitor of spinal cord ischemia during temporary occlusion of the thoracic aorta.
The reliability of evoked spinal cord potentials elicited by direct stimulation of the cord as a monitor of spinal cord ischemia during temporary occlusion of the thoracic aorta.
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通过直接刺激脊髓引起的脊髓诱发电位的可靠性作为胸主动脉暂时闭塞期间脊髓缺血的监测器。
DOI：
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发表时间：
1997
期刊：
影响因子：
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通讯作者：
K. Yasuda
中科院分区：
文献类型：
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作者：
Y. Matsui;N. Shiiya;K. Ishii;T. Murashita;S. Sasaki;M. Sakuma;K. Yasuda
截瘫是胸主动脉手术的严重和灾难性的并发症。为了预防这一并发症的发生，我们在83例不同类型的主动脉病变患者(夹层动脉瘤37例，未夹层动脉瘤46例，降主动脉瘤35例，胸腹主动脉瘤48例)术中应用脊髓直接刺激诱发的脊髓电位(ESPs-DSC)。所有患者在主动脉阻断期间都有不同形式的循环附属物。在83名患者中，有3名患者出现了“即刻”截瘫，5名患者出现了“即刻”截瘫，而另外3名患者则出现了“迟发性”截瘫。术中观察到4种类型的ESPs-DSC反应模式：(1)无变化(n=57)，(2)变而返(n=15)，(3)变而不一致(n=6)，(4)变而不返(n=5)。出现“迟发性”截瘫的有2例，出现“无变化”和“有变化”反应的有2例(3%)，出现“即刻”瘫痪的有3例，出现“迟发性”截瘫的有1例，出现“变化不一致”反应的有1例(67%)，全部出现“有变化但有不一致的返回”反应的患者(67%)，所有有“变化无返回”反应的患者发生“即刻”截瘫(100%)。我们认为，术中应用ESPs-DSC监测脊髓功能是脊髓缺血的良好指标，并可根据其变化改善预后。
Paraplegia is a severe and disastrous complication of operations on the thoracic aorta. For preventing this complication, we employed evoked spinal cord potentials elicited by direct stimulation of the cord (ESPs-dsc) during operations on 83 patients with various aortic lesions (37 dissecting and 46 cases of nondissecting aneurysms, 35 descending and 48 thoracoabdominal aortic aneurysms). All of the patients had some form of circulatory adjunct during aortic cross-clamping. Of the 83 patients, three had "immediate" paraparesis and five had "immediate" paraplegia, whereas three other patients had "delayed" paraplegia. During operation, four types of ESPs-dsc response pattern were observed: (1) no change (n = 57), (2) change with return (n = 15), (3) change with inconsistent return (n = 6), (4) change without return (n = 5). "Delayed" paraplegia occurred in two patients with "no change" and "change with return" response (3%), "immediate" paralysis occurred in three and "delayed" paraplegia occurred in one of those with "change with inconsistent return" response (67%), and all of those with "change with inconsistent return" response (67%), and all of those with "change without return" response developed "immediate" paraplegia (100%). We conclude that intraoperative monitoring of spinal cord function utilizing ESPs-dsc is a good indicator of spinal cord ischemia and we can improve the outcome according to its changes.