Jellish W S, Blakeman B, Warf P, Slogoff S
Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Anesth Analg. 1999 Feb;88(2):292-7. doi: 10.1097/00000539-199902000-00012.
We compared the effect of three different asymmetric sternal retractors on brachial plexus dysfunction using intraoperative somatosensory evoked potentials (SSEPs). We studied 60 patients undergoing coronary bypass and internal mammary harvest. Assessment of brachial plexus function was performed pre- and postoperatively. Patients were assigned the use of a Pittman (MN Scientific Instruments Inc., Minneapolis, MN), Rultract (Rultract Inc., Cleveland, OH), or Delacroix-Chevalier (Delacroix-Chevalier, Paris, France) asymmetric sternal retractor for internal mammary exposure. SSEP changes from baseline during asymmetric retractor use and removal were determined, and average changes were compared among the retractor groups. Patient demographics and baseline SSEP values were similar. Fewer patients in the Delacroix-Chevalier group had decreases in SSEP amplitudes after retractor placement. Of the patients in the Rultract and Pittman groups, 45% and 25%, respectively, had amplitude decreases of >50%, compared with only 5% of the Delacroix-Chevalier patients. Three patients in both the Pittman and Rultract groups and one patient in the Delacroix-Chevalier group suffered brachial plexus symptoms postoperatively. We conclude that the Delacroix-Chevalier retractor is associated with less neurophysiologic evidence of brachial plexus dysfunction during asymmetric sternal retraction compared with either the Pittman or Rultract sternal retractors.
We used somatosensory evoked potentials to assess the effect of several different asymmetric sternal retractors on brachial plexus dysfunction and to determine which produced the least evidence of nerve damage during surgical exposure of the internal mammary artery.
我们使用术中体感诱发电位（SSEP）比较了三种不同的不对称胸骨牵开器对臂丛神经功能障碍的影响。我们研究了60例接受冠状动脉搭桥术和获取乳内动脉的患者。术前和术后对臂丛神经功能进行评估。患者被分配使用皮特曼（MN Scientific Instruments Inc.，明尼阿波利斯，明尼苏达州）、鲁尔特拉克（Rultract Inc.，克利夫兰，俄亥俄州）或德拉克罗瓦 - 谢瓦利埃（德拉克罗瓦 - 谢瓦利埃，巴黎，法国）不对称胸骨牵开器来暴露乳内动脉。确定了在使用和移除不对称牵开器期间SSEP相对于基线的变化，并比较了牵开器组之间的平均变化。患者的人口统计学特征和基线SSEP值相似。德拉克罗瓦 - 谢瓦利埃组中，放置牵开器后SSEP波幅降低的患者较少。在鲁尔特拉克组和皮特曼组的患者中，分别有45%和25%的患者波幅降低超过50%，而德拉克罗瓦 - 谢瓦利埃组患者中这一比例仅为5%。皮特曼组和鲁尔特拉克组各有3例患者以及德拉克罗瓦 - 谢瓦利埃组有1例患者术后出现臂丛神经症状。我们得出结论，与皮特曼或鲁尔特拉克胸骨牵开器相比，德拉克罗瓦 - 谢瓦利埃牵开器在不对称胸骨牵开过程中与臂丛神经功能障碍的神经生理学证据较少相关。
我们使用体感诱发电位来评估几种不同的不对称胸骨牵开器对臂丛神经功能障碍的影响，并确定在乳内动脉手术暴露期间哪种牵开器产生的神经损伤证据最少。
