DNEPs在缺血性脊髓损伤手术中的变化及其意义

The change and value of spinous process stimulation motor-evoked potentzals during spinal cord ischemic injury

目的观察兔子不同程度缺血性脊髓损伤后经棘突电刺激下传神经源性运动诱发电位(DNEPs)的变化特点,为在脊柱脊髓手术中持续监测脊髓功能提供理论依据。方法通过不同程度的永久性脊髓缺血动物模型,研究经棘突间接电刺激运动诱发电位在缺血早期的变化特点,并分析波形变化与运动功能的相关性。结果经棘突电刺激间接脊髓运动诱发电位对缺血性损伤敏感,血管结扎后30min的波幅与运动功能呈显著性正相关,Pearson相关系数r=0.976,早期波幅变化可以评估预后,波幅与基线的比值与病理损害程度相关。结论经棘突电刺激间接脊髓运动诱发电位可以用于脊柱脊髓手术中连续监测脊髓功能,其对缺血敏感,与运动功能相关,术中应用可以预防术后术后神经功能障碍。

Objective The spinous process stimulation Descending Neurogenic Evoked Potentials （DNEPs） were monitored in a rabbit model of different levels of spinal cord isehemia to evaluate their accuracy and relationship to clinical status. The value of DNEPs monitoring during surgery is also observed. Methods A modified rabbit spinal cord ischemia model of different levels of permanent spinal cord ischemia was employed （23 rabbits） , after baseline DNEPs were obtained, evoked potentials were recorded continuously during and after clamping of the segmental spinal artery （60min）. Neurological outcome at 48h was correlated with evoked potentials, and histopathological findings. Results The spinous process stimulation DNEPs were sensitive to spinal cord ischemia. There were significant positive correlation between the motor function 2 days after Lumbar artery ligation and the amplitude changes 30min after ligation. The Pearson correlation coefficient is r = 0.976. Prognosis can be predicted with the change of the ratio of amplitude with the baseline. A close correlation between intraoperative monitoring and clinical outcome is observed. With the increase of the number vascular occlusion ,the pathological damage degree aggravated. Conclusions DNEPs selectively reflect transmission in spinal cord motor neuron pathways, and can detect within minutes the interruption of spinal cord blood supply.