节段性血管阻断对脊髓传导功能的影响

A study for the effect of the ligation of the spinal segmental vessel on the spinal cord electroconduction function

目的 :探讨阻断节段性血管对脊髓传导功能的影响 ,分析节段性血管阻断时脊髓缺血的高危因素。方法 :对31例胸段脊柱侧凸前路凸侧开胸患者游离节段性血管 ,在距离椎间孔 2 0cm处阻断T5～T1 1的节段性血管 ,于阻断前 5min ,阻断后 2、7、1 2及 1 7min分别记录SEP ,用基本波形、P40潜伏期、P40波幅 (峰 峰 ,峰 基 )对SEP的变化进行评价。结果 :P40波幅 (峰 峰 )在阻断 2min时显著降低 ,平均下降 0 64μV(2 6 1 2 % ) ,而P40潜伏期在 2min及7min显著延长 ,分别延长 1 2 2ms(3 39% )和 0 81ms(2 76 % )。SEP波形在血管阻断后 2、7、1 2及 1 7min时无明显变化 ,均为Ⅲ级或Ⅳ级。结论 :脊柱侧凸前路手术中 ,对于无血管畸形的患者 ,阻断单侧多根节段性血管可暂时影响脊髓传导功能 ,主要发生在阻断后前 7min内 ,此后脊髓传导功能恢复正常 ,并不导致临床上脊髓缺血性功能损害。

Objective:To investigate the effect of the ligation of the spinal segmental vessel on the spinal cord electroconduction function and analyse the potential risk for the cord ischemia.Method:31 cases of the thoracic scoliosis who underwent the anterior surgery.After the routine thoracotomy,the T5～T11 segmental vessel of the convexe side were clamped at the point of 2cm from the intravertebra foramen,5min after the stable SEP monitoring and the SEPs were recorded at 2?7?12?17min.The SEP was analysed with 3 indices i.e.SEP curve formation,P40 latency and P40 amplitude(peak to peak,peak to baseline).Result:All the SEP curves recorded were regular and recognizable during the test.P40 amplitude(peak to peak) declined by 0 64μV (26 12%) on average at 2min after clamping,while the P40 latency was significantly prolonged by 1 22ms(3 39%) and 0 81ms(2 76%) respectively at 2min and 7min after clamping.Conclusion:The unilateral interruption of the blood supply to the spinal cord from the segmental vessel may temporarily disturb the spinal cord electroconduction in the first 7min,but the spinal cord electroconduction may come back normal and there is no ischemic injury of the cord.