Doğan Orhan V, Düzgün Cemal, Ozeren Murat, Alanoğlu Ece, Doğan Süheyla, Simşek Erdal, Yücel Ertan
Social Security Training Hospital, Cardiovascular Surgery Clinic, Ankara, Turkey.
J Card Surg. 2006 Mar-Apr;21(2):151-4. doi: 10.1111/j.1540-8191.2006.00197.x.
There are few reports about injury to forearm nerves and its potential mechanisms during radial artery (RA) harvesting. We studied electrophysiologic changes in these nerves not sought until now.
Among 152 consecutive patients who underwent coronary artery bypass surgery between February 2002 and August 2002, 20 were randomized for RA harvesting and formed the study group and 20 were randomized as control group. Neurologic examination and electrophysiologic studies were performed for sensory and motor impairment of the nerves in both groups pre- and postoperatively.
There was no change on neurologic examinations before and after surgery. Electromyography (EMG) revealed significant reduction in sensory and motor conduction amplitudes of median, ulnar, and radial nerves and motor conduction velocities of median and ulnar nerves at the level of forearm in the study group. In the control group, ulnar nerve was mostly affected. When two groups are compared, sensory and motor amplitude drops of median and radial nerves and motor velocity impairment of median nerve in the study group are significant. Ulnar nerve impairments are identical in both groups.
Handling of tissues, minor hematoma or edema along with chest retraction best explains these impairments. Patients were asymptomatic after surgery showing that EMG is highly sensitive and is not predictive of clinical impairment.
关于桡动脉（RA）采集过程中前臂神经损伤及其潜在机制的报道较少。我们研究了目前尚未关注的这些神经的电生理变化。
在2002年2月至2002年8月期间连续接受冠状动脉搭桥手术的152例患者中，20例被随机分配进行桡动脉采集，组成研究组，另外20例被随机作为对照组。对两组患者术前和术后神经的感觉和运动功能障碍进行神经学检查和电生理研究。
手术前后神经学检查无变化。肌电图（EMG）显示研究组前臂水平的正中神经、尺神经和桡神经的感觉和运动传导幅度以及正中神经和尺神经的运动传导速度显著降低。在对照组中，尺神经受影响最大。两组比较时，研究组正中神经和桡神经的感觉和运动幅度下降以及正中神经的运动速度受损显著。两组尺神经损伤情况相同。
组织处理、轻微血肿或水肿以及胸部牵拉最能解释这些损伤。患者术后无症状，表明肌电图高度敏感，但不能预测临床损伤。
