孙氏手术中诱发电位监测的结果及意义

Remits and significance of evoked potentials monitoring in Sun＇ s procedure

目的评价孙氏手术对脊髓的影响，探讨孙氏手术截瘫发生的机制。方法本研究为前瞻性研究。2014年6月至2015年3月，57例孙氏手术中男37例，女20例；年龄（43．5±9．3）岁。术中监测诱发电位变化。根据术中诱发电位评价脊髓功能，结合临床结果以及术后短期随访结果评价孙氏手术对脊髓功能的影响。结果诱发电位在体外循环开始后，随温度降低而逐渐消失；复温过程中，波形逐渐恢复。所有病例的诱发电位均恢复正常。术后院内死亡1例，瘫痪2例（分别于术后12、21h发生），急性肾衰2例。术后平均随访9（3-11）个月，无迟发性脊髓损伤。结论孙氏手术术中对脊髓无影响，发生截瘫与术后假腔闭合致脊髓血供受损有关。

Objective To evaluate the influence of Sun＇ s procedure to spinal cord and to investigate the mechanism of paraplegia associated with Sun＇ s procedure. Methods This is prospective study from June 2014 to March 2015, 57 patients [ male 37, female 20, （43.5 ± 9.3 ） years ] undergoing Sun＇ s procedure were intraoperatively monitored the evoked potentials （EP） in Beijing Anzhen Hospital. The spinal cord function was evaluated via EP. The influence to spinal cord was evaluated by clinical results and short-period following-up results. Results EP wave faded away and vanished following the gradually drop of body temperature after cardiopulmonary bypass. And EP wave recovered gradually during rewarm process. All EP waves restored to normal at the end of operations. One case died in-hospital. There were paralysis in 2 cases and acute kidney dys- function in 2 cases. The median follow-up after operation was 8 （ 1 - 11 months）. There was no delayed neurologlc deficit. Conclusion The Sun＇ s procedure did not disturb spinal cord during operation. The possible reason of post-operative paralysis was the occlusion of false lumen.