颈椎损伤后手术中脊髓保护措施的效果探讨

The clinical observation of protection of spinal cord during the cervical vertebral surgery

目的探讨颈椎损伤后手术中脊髓保护措施的效果。方法强迫位下清醒/快速诱导气管插管后,部分患者行控制性降压、脱水、利尿、适度过度通气、皮层体感诱发电位(CSEP)监测;截瘫患者行双下肢弹性绷带缠裹。结果快速诱导插管较清醒插管难度明显降低(P<0.05),术后并发症减少;控制性降压明显减少术中出血量(P<0.01),显露清晰,方便椎管内操作;脱水、利尿、适度过度通气使椎管内压明显降低,硬膜、脊髓损伤减少;截瘫患者弹性绷带缠裹后,术中脊髓血供改善;CSEP监测可规避术中误伤脊髓的发生。结论颈椎手术中脊髓保护应从诱导插管、术中管理多个环节加以落实,方可获得理想的脊髓保护效果。

Objective To find out the effects of protection measure for spinal cord.Method After waken /fast induced tracheal i ntu-bation under the forced position,certain patients were used by induced h ypotension,dehydrate,diuresis,a vailable hyperventilation,cortic al somatosensory evoked potential(CSEP)monitoring during spinal surgery;T he lower limbers of paraplegia patie nts were twined by flexible bandage.Results The difficult tracheal intubation r ate under fast induced was more less t han that under waken intubation(P<0.05),which fallen the cases of post-operative c omplication The blood loss under induced hypotension was greatly reduce d comparing with control(P<0.01),which made the operation field clea rly and convenience surgeon to perfo rm in vertebral catheter;vertebral catheter pressure(VCP)was decreased by dehydrate,diuresis an d available hyperventilation,whic h evade the cervical putamen and spin al cord to be harm during cervical vertebral surgery;The circulation condition of spinal cord of paraplegia patients was improved quietly aft er twined by flexible bandage;CSEP monitoring can elude spinal cord to b e injured.Conclusion To realize the protection effects fo r spinal cord perfectly,certain measure would be carried out at multi-tache as procession of intubation,intro-operativ e management.etc in cervical verteb ral surgery.