摘要
目的探讨术中体感诱发电位和脑脊液生化指标对胸腹主动脉置换术术后并发症的影响。方法分析阜外华中心血管病医院和河南省人民医院2018年8月至2021年8月进行胸腹主动置换术的56例患者的临床资料。所有患者监测术中体感诱发电位变化, 并在术后采集脑脊液, 检测脑脊液中胶质纤维酸蛋白(GFAP)、神经丝蛋白亚单位(NFL)和S100B蛋白表达水平。56例患者根据是否出现脊髓损伤分为损伤组和无损伤组, 分别比较两组患者术中体感诱发电位和脑脊液生化指标(GFAP、NFL和S100B)的变化。正态分布组间比较采用t检验。结果 56例患者手术时间[(697.35±139.52) min], 体外循环时间[(192.87±75.56) min], 停循环时间[(17±4) min], 术后监护病房停留时间[(9.51±3.85) d]。术后脑脊液压力[(12.89±4.25) mmHg(1 mmHg=0.133 kPa)]。术后7例发生脊髓损伤, 其中即刻性瘫2例, 延迟性瘫5例, 脊髓损伤发生率为12.5%。脊髓损伤组患者术中体感诱发电位阳性率[85.71%(6/7)]明显高于无损伤者[22.45%(11/49)], 差异有统计学意义(χ^(2)=12.901, P>0.05)。脊髓无损伤组患者脑脊液压力[(9.18±3.14) mmHg]与无损伤者术中体感诱发电位阳性率[(13.25±4.29) mmHg]比较, 差异无统计学意义(t=3.012, P<0.05);脊髓无损伤组患者脑脊液GFAP、NFL和S100B水平[(0.41±0.15)、(4.36±0.59)、(1.23±0.18) ng/ml]明显低于脊髓无损伤组患者[(0.79±0.11)、(6.69±0.79)、(2.24±0.27) ng/ml], 差异有统计学意义(t=3.109、2.901、3.328, P<0.05)。结论体感诱发电位和脑脊液指标变化与胸腹主动脉置换术后脊髓损伤密切相关。
Objective To investigate the effects of intraoperative somatosensory evoked potential and cerebrospinal fluid biochemical indexes on postoperative complications of thoracoabdominal aortic replacement.Methods The clinical data of 56 patients who underwent thoracoabdominal active replacement in Fuwai Huazhong Cardiovascular Hospital Heart Center,Henan Provincial People’s Hospital from August 2018 to August 2021 were analyzed retrospectively.The changes of somatosensory evoked potential during operation were monitored in all patients,and cerebrospinal fluid was collected after operation.The expression levels of glial fibrillary acid protein(GFAP),neurofilament subunit(NFL)and S100B protein in cerebrospinal fluid were detected.Totally,76 patients were divided into injury group and no injury group according to whether there was spinal cord injury.T-test was used for comparison between normal distribution groups.Results The operation time of 56 patients was(697.35±139.52)min,the cardiopulmonary bypass time was(192.87±75.56)min,the circulatory arrest time was(17±4)min,and the stay time in the postoperative monitoring room was(9.51±3.85)d.Postoperative cerebrospinal fluid pressure was(12.89±4.25)mmHg(1 mmHg=0.133 kPa).Spinal cord injury occurred in 7 cases after operation,including 2 cases of immediate paralysis and 5 cases of delayed paralysis.The incidence of spinal cord injury was 12.5%.The positive rate of intraoperative somatosensory evoked potential in patients with spinal cord injury[85.71%(6/7)]was significantly higher than that in patients with non-invasive injury[22.45%(11/49),χ^(2)=12.901,P>0.05].The levels of GFAP,NFL and S100B in cerebrospinal fluid[(0.41±0.15),(4.36±0.59),(1.23±0.18)ng/ml respectively]in patients with spinal cord injury were significantly lower than those in the patients without spinal cord injury[(0.79±0.11),(6.69±0.79),(2.24±0.27)ng/ml,t=3.109,2.901,3.328,P<0.05].Conclusion The changes of somatosensory evoked potential and cerebrospinal fluid indexes are closely related to s
作者
王韬甫
吴亚辉
张志东
李晓健
王国权
林洪启
程兆云
Wang Taofu;Wu Yahui;Zhang Zhidong;Li Xiaojian;Wang Guoquan;Lin Hongqi;Cheng Zhaoyun(Fuwai Huazhong Cardiovascular Hospital Heart Center,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Department of Cardiac Surgery,Fuwai Huazhong Cardiovascular Hospital Heart Center,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Department of Peripheral Vascular Surgery,Fuwai Huazhong Cardiovascular Hospital Heart Center,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Department of Adult Cardiac Surgery,Fuwai Huazhong Cardiovascular Hospital,Henan Provincial People’s Hospital Cardiac Center,Zhengzhou 450003,China)
出处
《中华实验外科杂志》
CAS
北大核心
2022年第2期369-371,共3页
Chinese Journal of Experimental Surgery
基金
2019年河南省联合共建项目(LHGJ20190806)。
关键词
体感诱发电位
脑脊液压力
胸腹主动脉置换术
Somatosensory evoked potential
Cerebrospinal fluid pressure
Thoracoabdominal aortic replacement
