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Evoked Spinal Cord Potential (ESP) for Detection and Prevention of Spinal Cord Ischemia During Aortic Cross-Clamping.

脊髓诱发电位 (ESP) 用于检测和预防主动脉阻断期间脊髓缺血。

基本信息

批准号：
61480290
负责人：
YASUDA Keishu
金额：
$ 2.75万
依托单位：
Hokkaido 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：
1986
资助国家：
日本
起止时间：
1986 至 1987
项目状态：
已结题

项目摘要

Evoked spinal cord potential (ESP) was recorded and analyzed in order to detect and prevent the paraplegia caused by spinal cord ischemia during thoracic aortic cross-ciamping.(1) Experiment.Material and Methods: Adult dogs underwent continuous monitoring of ESP before, during, and after aortic cross-clamping. Stimulating electrodes were placed in the epidural space near L-1, sensing electrodes were placed in the intervertebral disc between T-3 and T-5. 5 to 100 responses were averaged to construct %e%sP..Results: ESP responses to aortic cross-clamping were categorized into three types: loss of ESP during aortic cross-clamp (type 1),'no change in ESP during cross- clamp (type 2), and transient depression and return of ESP during cross-clamp (type 3). All dogs of type 1 response demonstrated paraplegia, where-as no dog of type 2 response showed paraplegia. Some dogs of type 3 response demonstrated spastic paraplegia. Although cross-clamp was removed 10 minutes after ESP became 20% of the previous amplitude in another series of type 1 dogs, paraplegia was not prevented.Histological examination revealed infarction of the grey matter of the spinal cord below T-8 in the dogs with paraplegia.Selective perfusion of the intercostal arteries furing cross-clamping and intraaortic infusion of vasodilators seemed promising to prevent spinal cord ischemic injury.(2) PracticeESP was monitored in 30 patients who underwent thoracic aortic surgery.23 patients showed type 2 response. ESP was slightly depressed in 4 patients. 3 patients demonstrated type 1 response; temporary bypass was re-established in one case, cross-clamp could be released within a few minutes after ESP loss in other two cases. No paraplegia was experienced.We have invented a special bypass tube to perfuse intercostal arteries during aortotomy in case of prolonged type 1 response which strongly suggests spinal cord ischemia.

记录并分析脊髓诱发电位(ESP)，以检测和预防胸主动脉夹闭过程中脊髓缺血引起的截瘫。(1)实验材料与方法：成年犬在主动脉夹闭前、过程中和结束后对ESP进行连续监测。刺激电极放置在L-1附近的硬膜外腔中，传感电极放置在T-3和T-5之间的椎间盘中。平均 5 至 100 个反应以构建 %e%sP。结果：主动脉交叉钳夹的 ESP 反应分为三种类型：主动脉交叉钳夹期间 ESP 丢失（类型 1）、交叉钳夹期间 ESP 无变化（类型 2）以及交叉钳夹期间 ESP 短暂抑制和恢复（类型 3）。所有 1 型反应的狗均表现出截瘫，而 2 型反应的狗均未表现出截瘫。一些3型反应的狗表现出痉挛性截瘫。尽管在另一组 1 型犬中 ESP 达到先前振幅的 20% 后 10 分钟去除十字夹，但并没有预防截瘫。组织学检查显示截瘫犬 T-8 以下脊髓灰质梗塞。交叉钳制的肋间动脉选择性灌注和主动脉内输注血管扩张剂似乎有希望预防脊髓缺血。 (2)对30例接受胸主动脉手术的患者进行ESP监测，其中23例患者表现出2型反应。 4 名患者的 ESP 轻度下降。 3名患者表现出1型反应；在一种情况下，临时旁路被重新建立，在另外两种情况下，十字夹可以在 ESP 丢失后几分钟内释放。没有发生截瘫。我们发明了一种特殊的旁路管，用于在主动脉切开术期间灌注肋间动脉，以防出现长时间的 1 型反应，这强烈表明脊髓缺血。