Monitoring of motoneuron activity for spinal cord ischemia

监测脊髓缺血的运动神经元活动

• 批准号: 03454330
• 负责人: KAMIYA Kihatirou
• 金额: $ 3.46万
• 依托单位: Yamanashi Medical University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (B)
• 财政年份: 1991
• 资助国家: 日本
• 起止时间: 1991 至 1992
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-03454330/
• 关键词: Spinal cord ischemia; paraplegia; F wave; monitoring; thoracoabdominal aortic aneurysm; thoracic aortic aneurysm; electromyography; motoneuron; 脊髓誘発電位; F wave; 脊髓虚血; F-P complex; 脊髓前角細胞; 下波; FPC; SEP; 脊髄誘発電位

The F-wave/polysynaptic responses complex (FPC) which is recorded on a plantar region after electric stimulation of the tibial nerve is a group of potentials reflecting the excitement of the anterior horn cells at the L-5 level of spinal cord. We evaluated the utility of FPC monitoring for spinal cord ischemia in the context of thoracic aortic surgery, experimentally and clinically.Twenty four dogs were subjected to the balloon catheter occlusion of both the distal thoracic aorta and the left internal mammary artery under pentobarbital anesth esia. Half of the dogs were treated with no muscle relaxants and the other half were with a non-depolarizing muscle relaxant, pancuronium. The FPCs were well monitored even if the muscle relaxant was used and were lost within 3 minutes after the completion of the balloon arterial occlusion in all dogs. They were divided into four groups, A,B,C, and D, according to arterial occlusion time after the loss of the FPCs, 20,30,40, and 50 minutes, respectively. Incidence of paraplegia was 0% (0/6) in Group A, 33% (2/6) in Group B, 83% (5/6) in Group C (A vs C : P<0.01), and 100% (6/6) in Group D.The FPCs were monitored in 13 patients who underwent graft replacement for thoracic or thoracoabdominal aortic aneurysms. The operations were performed with temporary bypass or partial cardiopulmonary bypass. The FPCs were lost in 7 patients after aortic clamping or intercostal artery ligation. Paraplegia or paraparesis occurred in two of three patients that aortic reconstruction was completed in beyond twenty minutes after the loss of the FPCs.In conclusion, FPC monitoring is a usefull method for detection of spinal cord ischemia and reconstruction of the spinal cord blood flow within 20 minutes after the loss of the FPC may prevent postoperative paraplegia nearly completely.

电刺激胫神经后在足底区域记录的F波/多突触反应复合体（FPC）是反映脊髓L-5水平前角细胞兴奋的一组电位。我们在实验和临床上评估了 FPC 监测在胸主动脉手术中脊髓缺血的实用性。 在戊巴比妥麻醉下，对 24 只狗进行了远端胸主动脉和左内乳动脉的球囊导管闭塞。一半的狗没有接受肌肉松弛剂治疗，另一半则接受非去极化肌肉松弛剂泮库溴铵治疗。即使使用了肌肉松弛剂，FPC 也得到了很好的监测，并且在所有狗的球囊动脉闭塞完成后 3 分钟内 FPC 就消失了。根据FPC丢失后动脉闭塞时间分别为20、30、40和50分钟，将他们分为四组：A、B、C和D。 A组截瘫发生率为0%（0/6），B组为33%（2/6），C组为83%（5/6）（A vs C：P<0.01），D组为100%（6/6）。对13例因胸或胸腹主动脉瘤接受移植物置换的患者进行FPC监测。手术是通过临时搭桥或部分体外循环进行的。 7 名患者在主动脉夹闭或肋间动脉结扎后 FPC 丢失。 FPC 丢失后 20 分钟内完成主动脉重建的 3 名患者中，有 2 名发生截瘫或下肢轻瘫。 总之，FPC 监测是检测脊髓缺血的有效方法，FPC 丢失后 20 分钟内重建脊髓血流可以几乎完全预防术后截瘫。

项目成果

神谷喜八郎: "大動脈遮断に伴う脊髄虚血に対するE-P complex モニタリング法の実験的研究" 日本外科学会雑誌. 89. 473 (1988)

Kihachiro Kamiya：“主动脉闭塞相关脊髓缺血的 E-P 复合监测方法的实验研究”日本外科学会杂志 89. 473 (1988)。

Kihachiro Kamiya: "Monitoring of F waves and polysynaptic responses (F-P conplex) for spinal cord ischemia in aortic surgery- an experimental study" Journal of Japan Surgical Society. 89. 473 (1988)

Kihachiro Kamiya：“主动脉手术中脊髓缺血的 F 波和多突触反应（F-P 复合体）的监测 - 一项实验研究”日本外科学会杂志。

神谷 喜八郎 他: "大動脈遮断に伴う脊髓虚血に対するF-P complexモニタリング法の実験的研究" 日本外科学会雑誌. 89. 473- (1988)

Kihachiro Kamiya 等：“主动脉闭塞相关脊髓缺血的 F-P 复合监测方法的实验研究”日本外科学会杂志 89. 473- (1988)。