脊髄虚血による対麻痺のモニター法と遅発性麻痺への新しい管理法の開発

脊髓缺血性截瘫监测方法及迟发性截瘫新治疗方法的开发

• 批准号: 19K18269
• 负责人: 川島 信吾
• 金额: $ 2.75万
• 依托单位: Hamamatsu University School of Medicine
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Early-Career Scientists
• 财政年份: 2019
• 资助国家: 日本
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-19K18269/
• 关键词: 脊椎灌流; 臓器保護; 出血性ショック; 近赤外分光法; 脊髄灌流; 脊髄虚血

胸腹部大動脈瘤術後の対麻痺の発生率は今だに3－16％と高頻度である。対麻痺が発生した場合にはADLの著しい低下だけでなく生命予後が悪化する。近年運動誘発電位（MEP）を脊髄虚血のモニターとしながら手術するのが主流であるが、MEPは偽陽性も多く、全身麻酔下しか使用できない。さらに術中のMEPでは近年増加傾向にある遅発性対麻痺の早期発見や予測ができない。近赤外分光法（Near-infrared spectroscopy:以下NIRS）は非侵襲的に組織酸素化が測定できるため、脳梗塞予防のモニターとして脳の酸素化を心臓手術を中心に使用するのが一般的になっている。NIRSを術中、術後の脊髄虚血のモニターとして利用する可能性を探るため、実際に脊髄虚血時にはNIRS、MEP、レーザードップラー血流計(LDF)がどのように変化するか、様々な文節での虚血に対してどのレベルでのNIRSがどう変化するかを明らかにする。体重25-30 kgのブタを用いる（約20匹予定）。イソフルランの吸入により麻酔導入し、挿管、人工呼吸下にイソフルランを呼気終末濃度2％（ブタ1MAC）で維持する。右大腿動脈に血管確保し大動脈バルーン閉塞用カテーテルを挿入、左前後の足に動脈圧ライン、右内頚静脈に肺動脈カテーテルおよび中心静脈カテーテルを留置する。ブタを腹臥位にして、第4－6胸椎と第1－3腰椎の棘突起および椎弓を削り（椎間で黄色靭帯が露出する深さまで）プローベが装着可能な水平面を作成後、NIRSプローベを装着する。同レベルの傍脊椎の筋肉組織（主に椎脊柱起立筋）、開胸した時の椎体側部の筋肉組織（脊柱起立筋、大腰筋、腰方形筋など）にもNIRSプローベを装着する。脊髄虚血モニターのコントロールとしてMEP電極を頭部に、露出した椎間とNIRSを装着した傍脊椎部と椎体側面よりLDFを挿入する

The birth rate of poliomyelitis caused by massive tumor in chest and abdomen is now 16%. I don't know. I don't know. In recent years, MEP has been used to treat deficiency of blood, blood deficiency, hand surgery, mainstream medicine, MEP, and general anaesthesia. In recent years, there has been an increase in the number of MEP drugs in the past few years. Near-infrared spectroscopy (Near-infrared spectroscopy: the following NIRS) non-invasive tissue acidification assay for the determination of tissue acidosis, the prevention of myocardial infarction and the use of acid in the heart surgery center. In the middle and later of the NIRS test, you can use the possibility of detection, NIRS, MEP, and LDF to detect the possibility of deficiency of the spine. in the future, you can use the possibility to detect the possibility of deficiency of the blood. in the future, you can use the possibility of detection, MEP, and monitoring of blood flow measurement (LDF). The body weight was 25-30 kg, and the animal weight was about 20 animals. Do not inhale the anaesthesia. Use the tube and artificial respiration to keep the temperature at the end of the temperature 2% (temperature 1MAC). The blood vessels of the right thigh should be protected and the blood vessels of the right thigh should be secured. the blood vessels of the right thigh should be plugged in, the left front and back of the foot, the right inner leg, the lung, the lung, the center, the center. In the 4-6 thoracic vertebrae, the spine processes of the 1st-3rd lumbar vertebrae and the pedicle of the lumbar vertebrae in the 4th-6th thoracic vertebrae, the lumbar spine processes and the pedicle of the lumbar vertebrae in the 4th-6th thoracic vertebrae, the spine processes of the 1st-3rd lumbar vertebrae in the 4th-6th thoracic vertebrae, the lumbar spine process and the pedicle of the 1st-3rd lumbar vertebrae in the 4th-6th thoracic vertebrae, the lumbar spine process and the pedicle of the 1st-3rd lumbar vertebrae in the 4th-6th thoracic vertebrae. After the horizontal plane was installed, the NIRS was installed. The NIRS muscle tissue adjacent to the spine (main spine standing tendon) and the vertebral body tendon tissue (spinal standing tendon, large lumbar tendon, waist square tendon) were installed during thoracotomy. The spinal cord blood deficiency was not affected. The MEP imaging was performed. The NIRS between the vertebrae and the vertebrae was exposed. The LDF was inserted into the vertebrae near the vertebrae.