布加氏综合征腔-房转流术的血流动力学研究及两种术式比较

Location Diagnosis Technique of the Motor NervousSystem Disorders by MultiMusculus MEPs

目的：探讨布加氏综合征（ＢｕｄｄＣｈｉａｒｉｓｙｎｄｒｏｍｅ）的血流动力学状态，腔房转流术围术期血流动力学变化及其与脾肺固定术的比较。方法：采用ＳｗａｎＧａｎｚ导管和外周动静脉直接测压获得血流动力学参数。结果：腔房转流组患者术前心排血量（ＣＯ）偏低，肺循环阻力指数（ＰＶＲＩ）、肺动脉压（ＰＡＲ）、肺动脉嵌入压（ＰＡＷＰ）显著降低，体循环阻力指数（ＳＶＲＩ）增高。麻醉诱导两组均显示心率（ＨＲ）上升，平均动脉压（ＭＢＰ）和心率收缩压乘积（ＲＰＰ）下降。腔房转流术ＣＯ、心脏指数（ＣＩ）、心搏指数（ＳＩ）、左室每搏功指数（ＬＶＳＷＩ）和右室每搏功指数（ＲＶＳＷＩ）显著下降。人造血管开放时ＣＯ、ＣＩ、ＳＩ、ＬＶＳＷＩ、ＲＶＳＷＩ、右房压（ＲＡＰ）、ＰＡＷＰ和ＰＡＰ大幅度上升，ＳＶＲＩ和下腔静脉压（ＩＶＣＰ）明显下降。脾肺固定组心率（ＨＲ）、血压（ＢＰ）和ＲＰＰ持续上升至术后。结论：布加氏综合征血流动力学状态属下腔静脉系统高容量、低回心血量型，麻醉可抑制循环。随着梗阻解除或侧枝循环建立，回心血量较大幅度增长，有发生心衰和肺水肿的危险。

Objective: The 384 cases of various motor nervous system disorders are investigated by multimusculus′ motor evoked potentials (MEPs).Methods: The descending motor tracts were activated using a high voltage transcutaneous electrical stimulation technique at the motor cortex and spinal cord.Multimusculus′ MEPs were recorded by 4channel recorders.Myomore distribution of the abnormal MEP waves and its parameters would indicat lesion location.Results: The results showed that the location diagnosis rates were 71.4%～100%.Conclusion: This new electrophysiological technique is a very useful tool for lesion location of the motor nervous system disorders.