摘要目的 通过观察皮质体感诱发电位(CSEP)和下传神经源性运动诱发电位(DNEP)在兔脊髓缺血早期的变化特点,探讨CSEP和DNEP在脊髓损伤早期评估中的作用.方法 通过结扎不同水平的腰动脉建立不同程度的永久性脊髓缺血损伤兔模型,分为5组(分别结扎左肾动脉和动脉分叉间不同水平的腰动脉,包括1～5根组),造模后连续记录CSEP和DNEP60min,2d后取缺血中心区标本进行HE染色.采用Tarlov运动功能评分评估运动功能.分析CESP和DNEP的波幅变化与结扎后运动功能的关系.结果 4根组和5根组的CSEP波幅与手术前的基线波幅百分比与结扎前相比,差异均有统计学意义(均P ＜0.05);而其他各组与结扎前相比,差异均无统计学意义(均P ＞0.05).3根组、4根组以及5根组的DNEP波幅与手术前的基线波幅百分比与结扎前相比,差异均有统计学意义(均P ＜0.05);而其他各组与结扎前相比,差异均无统计学意义(均P＞0.05).4根组和5根组结扎后2d的运动功能与结扎前相比,差异均有统计学意义(均P＜0.05);其他各组与结扎前相比,差异均无统计学意义(均P＞0.05).CESP和DNEP波幅变化与血管结扎后2d的运动功能呈正相关(r =0.97,P＜0.001;r =0.95,P＜0.001).结论 CSEP和DNEP均可预测脊髓损伤后的运动功能;DNEP对脊髓缺血性损伤更敏感,对运动功能更特异,能够在脊髓缺血早期发现缺血性损伤.

abstractsObjective To investigate the effect of early evaluation of cortical somatosensory evoked potentials (CSEP) and desending neurogenic motor evoked potentials (DNEP) in spinal cord ischemic injury by observing the early change characteristics of CSEP and DNEP of spinal cord ischemia in rabbits.Methods To establish a rabbit model with different degree of permanent spinal cord ischemic injury through the ligation of different levels of lumbar arteries.The rabbits were divided into 5 groups (ligation of the left renal artery and the different levels of lumbar arteries between arterial bifurcations respectively,including 1 to 5-artery group).After modeling,CSEP and DNEP were continuously recorded for 60 min.After 2 days,the samples of ischemic central area were selected for HE staining.The motor function score Tarlov criteria were used to assess the motor function.The relationship between the amplitude variation of CESP and DNEP and the motor function after ligation were analyzed.Results There were statistical significance in the percentages of the CSEP amplitude and preoperative baseline amplitude between the 4-and 5-artery groups compared with before ligation (P ＜ 0.05),and there were no statistical differences compared with other groups before ligation (all P ＞ 0.05).There were statistical differences in the percentages of the DNEP amplitude and preoperative baseline amplitude among the 3-,4-and 5 artery groups compared with before ligation (all P ＜ 0.05);and there was no statistical significance compared with before ligation in other groups (all P ＞ 0.05).Compare with before ligation,there were statistical significances in the motor function 2 days after ligation between the 4-and 5-artery group (all P ＜ 0.05),and compare with other groups before ligation,there were no statistical significances (all P ＞ 0.05).The amplitude variation of CSEP and DNEP was positively correlated with the motor function 2 days after ligation of blood vessels (r =0.97,P＜0.001;r=0.95,P＜0.001).Conclusions Both CSEP and DNEP can predict the motor function after spinal cord injury.DNEP is more sensitive to spinal cord ischemic injury and is more specific to motor function.It can find ischemic injury in the early spinal cord ischemia.