Matsui Y, Goh K, Shiiya N, Murashita T, Miyama M, Ohba J, Gohda T, Sakuma M, Yasuda K, Tanabe T
Department of Cardiovascular Surgery, Hokkaido University of Medicine, Japan.
J Thorac Cardiovasc Surg. 1994 Jun;107(6):1519-27.
Evoked spinal cord potentials elicited by direct stimulation of the cord were used to monitor spinal cord ischemia in 68 patients undergoing temporary occlusion of the thoracic aorta (29 thoracic nondissecting aortic aneurysms, 9 nondissecting thoracoabdominal aneurysms, and 30 dissecting aneurysms). "Immediate" postoperative paraplegia developed in three patients and "immediate" paraparesis developed in one, whereas "delayed" paraplegia developed in two others. During aortic crossclamping, four response patterns of the spinal cord potentials were obtained: (1) no change (n = 53), (2) change with return (n = 10), (3) change with inconsistent return (n = 2), and (4) change without return (n = 3). Neurologic complications occurred in 2%, 0%, 100% of these groups, respectively. Delayed paraplegia developed on the second postoperative day in only one patient with a false-negative result, and the potentials correlated well with this patient's clinical neurologic recovery. The aortic crossclamp time was significantly longer in the patients with "change with inconsistent return" and "change without return" than in the other two groups (p < 0.01). Femoral artery pressure and the cardiopulmonary bypass flow rate were also significantly lower in these groups than in the other two groups (p < 0.02 and p < 0.01, respectively). We conclude that intraoperative monitoring of direct spinal cord responses is useful for the early detection of spinal cord ischemia for assessing the efficacy of surgical countermeasures.
通过直接刺激脊髓诱发的脊髓诱发电位被用于监测68例接受胸主动脉临时阻断术的患者的脊髓缺血情况（29例胸段非夹层主动脉瘤、9例非夹层胸腹主动脉瘤和30例夹层动脉瘤）。3例患者术后出现“即刻”截瘫，1例出现“即刻”轻瘫，另外2例出现“延迟”截瘫。在主动脉交叉钳夹期间，获得了脊髓电位的四种反应模式：（1）无变化（n = 53），（2）变化并恢复（n = 10），（3）变化但恢复不一致（n = 2），（4）变化且未恢复（n = 3）。这些组中神经并发症的发生率分别为2%、0%、100%。仅1例假阴性结果的患者在术后第二天出现延迟性截瘫，电位与该患者的临床神经恢复情况相关性良好。“变化且恢复不一致”和“变化且未恢复”组的主动脉交叉钳夹时间显著长于其他两组（p < 0.01）。这些组的股动脉压和体外循环流量也显著低于其他两组（分别为p < 0.02和p < 0.01）。我们得出结论，术中监测脊髓直接反应有助于早期发现脊髓缺血，以评估手术对策的疗效。
