控制性降压对脊髓血流及诱发电位的影响
|
摘要
近年来，脊柱外科迅速发展。而脊柱外科手术常常出血量较大，如何减少术中出血、降低异体血输入量是麻醉医师和术者必须要面对的一个严重问题。在大中型脊柱外科手术中，常采用控制性降压以期减少出血。但是根据文献报告，在麻醉及血压降低的情况下，中枢神经系统不具备自动调节能力以维持脊髓血流，而是出现脊髓血流灌注降低可能不利于脊髓的保护。因此，值得探讨为减少出血进行控制性降压时，是否会增加神经系统损伤的危险性。
体感诱发电位(somatosensory evoked potential，SEP)和运动诱发电位(motor evoked potential，MEP)联合监测可反映脊髓、神经根功能的完整性，是目前脊柱外科术中脊髓、神经根功能监测的最主要手段。
本文应用激光多普勒血流仪研究尼卡地平控制性降压对家犬脊髓血流(spinal cord blood flow，SCBF)的影响，通过记录SEP和MEP变化观察尼卡地平控制性降压对家犬神经系统的影响，旨在探讨控制性降压的安全性。
一、控制性降压对脊髓血流的影响
目的：观察尼卡地平控制性降压对家犬脊髓血流的影响。方法：成年杂种犬6只，体重12～16kg，用2.5％硫贲妥钠行麻醉诱导、气管插管，术中持续静脉注射维持麻醉。股动脉置管监测(mean arterial pressure，MAP)。以尼卡地平8μg·kg~(-1)·min~(-1)持续静脉注射进行控制性降压，降压标准为平均动脉压降至术前基础平均动脉压的60％。以激光多普勒血流仪测定SCBF。结果：降压前MAP为125.7±10.6mmHg，降压后为72.0±11.2mmHg，平均下降42.9％。降压前SCBF为9.80±1.05v，降压后为8.04±0.96v，降低幅度17.9％。结论：尼卡地平在降低MAP同时，对SCBF影响较小。
二、控制性降压对脊髓诱发电位的影响
目的：观察尼卡地平控制性降压对家犬脊髓诱发电位的影响，探讨脊柱手术麻醉中尼卡地平控制性降压的安全性。方法：成年杂种犬6只，体重12～16kg，用2.5％硫贲妥钠行麻醉诱导、气管插管，术中持续静脉注射维持麻醉。股动脉置管监测MAP。以尼卡地平8μg·kg~(-1)·min~(-1)持续静脉注射进行控制性降压，降压标准为基础平均动脉压的60％。以日本光电诱发电位监测仪测定脊髓诱发电位。结果：MAP平均下降幅度为42.9％；控制性降压后SEP波幅(Asep)轻度降低，MEP波幅(Amep)无明显变化。结论：尼卡地平控制性降压对脊髓诱发电位(spinal cord evoked potentials，SCEPs)影响较小，可安全用于脊髓手术。
三、控制性降压对脊髓急性牵拉损伤影响
目的观察脊髓急性损伤情况下控制性降压对脊髓的影响，了解其在脊髓损伤情况下的安全性。方法成年杂种家犬12只，随机分为正常血压脊髓牵拉损伤组和控制性降压脊髓牵拉损伤组。经股动脉插入肝素化导管测定MAP。控制性降压组用尼卡地平以8ug·kg~(-1)·min~(-1)微泵持续推注进行控制性降压。经前后路联合离断脊柱后实施牵拉损伤。降压及不同程度牵拉前后前后测定持续测定MAP、SCBF，SEP及MEP。结果MAP平均下降幅度为40.5％；常压组与降压组的SCBF(％)、Asep(％)及Amep(％)无显著差异。结论控制性降压不影响脊髓对牵拉损伤的耐受性，尼卡地平是脊柱手术中安全的控制性降压药物。
The spinal surgery has developed very fast in recent years.But sometimesthere is a massive bleeding in these operations.Deliberate hypotension isnow often used in spinal surgery to reduce the amount of bloodtransfusion.But hypotension may cause the ischemia of the spine andinduce injury of the central nervous system.This study investigated theeffect of the deliberate hypotension on spinal blood flow and evokedpotentials.
Objective In order to evaluate the superiority of the controlledhypotension with nicadipine in spinal operation, the effect of nicardipineinduced hypotension on spinal cord blood flow(SCBF) and spinal cordevoked potentials(SCEPs) in dogs were investigated. Methods 6 adultmongrel dogs, weighing 12.0 kg to 16kg were used. Trachea and femoralartery were intubated after 2.5％thiopentone sodium(1ml·kg~(-1), iv) andanesthesia was maintained with continuous intavenous injection of 2.5％thiopentone sodium(1.1ml·kg~(-1)·h~(-1)). Controlled hypotension was inducedby continuous iv nicardipine(8μg·kg~(-1)·min~(-1)), which was defined as60％of basal mean arterial pressure(MAP). MAP was monitored and thechanges of spinal cord evoked potentials(SCEPs) after nicardipine (8μ g·kg~(-1)·min~(-1),iv) injection were observed by laser doppler flowmetry.Results Mean arterial blood pressure(MABP) decreased 42.9％withnicadipine, but there was little influence on SCBF. The amplitude ofmotor evked potential(MEP) did not change significantly while amplitudeof somatosensory evoked potential(SEP) fell at some extent. ConclusionNicardipine-induced hypotension only had less influence on SCEPs,which suggested that nicardipine probably could be safely used in spinaloperation.
In the comparative analysis on the effect of controlled hypotension tospinal cord distraction injury, nicadipine had mild influence on SCBF andSEP. The latency and amplitude of the MEP remained unchanged.And thesusceptibility of the spine to distraction injury is not increased while inhypotension condition induced by nicadipine.
体感诱发电位(somatosensory evoked potential，SEP)和运动诱发电位(motor evoked potential，MEP)联合监测可反映脊髓、神经根功能的完整性，是目前脊柱外科术中脊髓、神经根功能监测的最主要手段。
本文应用激光多普勒血流仪研究尼卡地平控制性降压对家犬脊髓血流(spinal cord blood flow，SCBF)的影响，通过记录SEP和MEP变化观察尼卡地平控制性降压对家犬神经系统的影响，旨在探讨控制性降压的安全性。
一、控制性降压对脊髓血流的影响
目的：观察尼卡地平控制性降压对家犬脊髓血流的影响。方法：成年杂种犬6只，体重12～16kg，用2.5％硫贲妥钠行麻醉诱导、气管插管，术中持续静脉注射维持麻醉。股动脉置管监测(mean arterial pressure，MAP)。以尼卡地平8μg·kg~(-1)·min~(-1)持续静脉注射进行控制性降压，降压标准为平均动脉压降至术前基础平均动脉压的60％。以激光多普勒血流仪测定SCBF。结果：降压前MAP为125.7±10.6mmHg，降压后为72.0±11.2mmHg，平均下降42.9％。降压前SCBF为9.80±1.05v，降压后为8.04±0.96v，降低幅度17.9％。结论：尼卡地平在降低MAP同时，对SCBF影响较小。
二、控制性降压对脊髓诱发电位的影响
目的：观察尼卡地平控制性降压对家犬脊髓诱发电位的影响，探讨脊柱手术麻醉中尼卡地平控制性降压的安全性。方法：成年杂种犬6只，体重12～16kg，用2.5％硫贲妥钠行麻醉诱导、气管插管，术中持续静脉注射维持麻醉。股动脉置管监测MAP。以尼卡地平8μg·kg~(-1)·min~(-1)持续静脉注射进行控制性降压，降压标准为基础平均动脉压的60％。以日本光电诱发电位监测仪测定脊髓诱发电位。结果：MAP平均下降幅度为42.9％；控制性降压后SEP波幅(Asep)轻度降低，MEP波幅(Amep)无明显变化。结论：尼卡地平控制性降压对脊髓诱发电位(spinal cord evoked potentials，SCEPs)影响较小，可安全用于脊髓手术。
三、控制性降压对脊髓急性牵拉损伤影响
目的观察脊髓急性损伤情况下控制性降压对脊髓的影响，了解其在脊髓损伤情况下的安全性。方法成年杂种家犬12只，随机分为正常血压脊髓牵拉损伤组和控制性降压脊髓牵拉损伤组。经股动脉插入肝素化导管测定MAP。控制性降压组用尼卡地平以8ug·kg~(-1)·min~(-1)微泵持续推注进行控制性降压。经前后路联合离断脊柱后实施牵拉损伤。降压及不同程度牵拉前后前后测定持续测定MAP、SCBF，SEP及MEP。结果MAP平均下降幅度为40.5％；常压组与降压组的SCBF(％)、Asep(％)及Amep(％)无显著差异。结论控制性降压不影响脊髓对牵拉损伤的耐受性，尼卡地平是脊柱手术中安全的控制性降压药物。
The spinal surgery has developed very fast in recent years.But sometimesthere is a massive bleeding in these operations.Deliberate hypotension isnow often used in spinal surgery to reduce the amount of bloodtransfusion.But hypotension may cause the ischemia of the spine andinduce injury of the central nervous system.This study investigated theeffect of the deliberate hypotension on spinal blood flow and evokedpotentials.
Objective In order to evaluate the superiority of the controlledhypotension with nicadipine in spinal operation, the effect of nicardipineinduced hypotension on spinal cord blood flow(SCBF) and spinal cordevoked potentials(SCEPs) in dogs were investigated. Methods 6 adultmongrel dogs, weighing 12.0 kg to 16kg were used. Trachea and femoralartery were intubated after 2.5％thiopentone sodium(1ml·kg~(-1), iv) andanesthesia was maintained with continuous intavenous injection of 2.5％thiopentone sodium(1.1ml·kg~(-1)·h~(-1)). Controlled hypotension was inducedby continuous iv nicardipine(8μg·kg~(-1)·min~(-1)), which was defined as60％of basal mean arterial pressure(MAP). MAP was monitored and thechanges of spinal cord evoked potentials(SCEPs) after nicardipine (8μ g·kg~(-1)·min~(-1),iv) injection were observed by laser doppler flowmetry.Results Mean arterial blood pressure(MABP) decreased 42.9％withnicadipine, but there was little influence on SCBF. The amplitude ofmotor evked potential(MEP) did not change significantly while amplitudeof somatosensory evoked potential(SEP) fell at some extent. ConclusionNicardipine-induced hypotension only had less influence on SCEPs,which suggested that nicardipine probably could be safely used in spinaloperation.
In the comparative analysis on the effect of controlled hypotension tospinal cord distraction injury, nicadipine had mild influence on SCBF andSEP. The latency and amplitude of the MEP remained unchanged.And thesusceptibility of the spine to distraction injury is not increased while inhypotension condition induced by nicadipine.
引文
1．邓小明等．常用实验动物麻醉．第一版．第二军医大学出版社．2001．6
2. Westergren H, Farooque M, Olsson Y, et al. Spinal cord blood flow changes following systemic hypothermia and spinal cord compression injury: an experimental study in the rat using Laser-Doppler flowmetry. Spinal Cord 2001; 39(2):74-84
3. Kling TF Jr, Wilton N, Hensinger RN, et al. The influence of trimethaphan (Arfonad)-induced hypotension with and without spine distraction on canine spinal cord blood flow. Spine 1986 Apr; 11(3): 219-24
4. Tator CH, Fehlings MG.. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991; 75: 15-26
5．宋福德，詹文林．控制性降压结合单纯血液稀释用于脊椎侧(后)凸矫正术临床观察．临床麻醉学杂志，2000，16：582．
6. Westergren H, Farooque M, Olsson Y, et al. Spinal cord blood flow changes following systemic hypothermia and spinal cord compression injury:an experimental study in the rat using Laser-Doppler flowmetry. Spinal Cord 2001; 39: 74
1. Westergren H, Farooque M, Olsson Y, et al. Spinal cord blood flow changes following systemic hypothermia and spinal cord compression injury:an experimental study in the rat using Laser Dopper flowmetry. Spinal Cord 2001; 39:74-84
2. Padberg AM, Wilson-Holden TJ, Lenke LG, et al. Somatosensory and motor evoked potential monitoring without a wake-up test during idiopathic scoliosis surgery. An accepted standard of care. Spine 1998; 23(12): 1392-1400
3. Charles H. Tator, M. D. Review of the scecondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. Neuro Surg 1991:75:15～26.
4. Richard D, Happel. Ca-accumulation in experimental spinal cord trauma. Brain Res 1981; 211:476～479.
5. Hersey SL, O'Dell NE, Lowe S, et al. Nicardipine versus nitroprusside for controlled hypotension during spinal surgery in adolescent. Anesth Analg 1997; 84:1239-1244
6. Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991; 75:15-26
7. Tymianski M, Tator CH. Normal and abnormal calcium homeostasis in neurons:a basis for the pathophysiology of traumatic and ischemic central nervous system injury. Neurosurgery 1996; 38:1176-95
8．许传清，陈文钊，曹飞等．用诱发电位术中监测脊髓功能的实验研究．临床麻醉学杂志 2002；18：596
1. Westergren H, Farooque M, Olsson Y, et al. Spinal cord blood flow changes following systemic hypothermia and spinal cord compression injury: an experimental study in the rat using Laser-Doppler flowmetry. Spinal Cord 2001;39(2):74-84
2. Mori K, Maeda T, Shiraishi Y, et al. Effects of hypothermia on blood flow and neural activity in rabbit spinal cord during postischemic reperfusion. Jpn J Physiol 2001; 51(1):71-9
3. Krengel WF 3rd, Robinson LR, Schneider VA. Combined effects of compression and hypotension on nerve root function. A clinical case. Spine 1993 Feb; 18(2):306-9
4. Yeoman PM, Gibson M J, Hutchinson A, et al. Influence of induced hypotension and spinal distraction on feline spinal somatosensory evoked potentials. Br J Anaesth 1989 Sep; 63(3):315-20
5. Spargo PM, Tait AR, Knight PR, et al. Effect of nitroglycerine-induced hypotension on canine spinal cord blood flow. Br J Anaesth 1987 May; 59(5):640-7
6. Kling TF Jr, Wilton N, Hensinger RN, et al. The influence of trimethaphan (Arfonad)-induced hypotension with and without spine distraction on canine spinal cord blood flow. Spine 1986 Apr; 11 (3):219-24
1 Pelosi L, Stevenson M, Hobbs GJ. Intraoperative motor evoked potentials to transcranial electrical stimulation during two anaesthetic regimens. Clin Neurophysiol. 2001 Jun; 112(6): 1076-87.
2 Fisher RS, Raudzens P, Nunemacher M. Efficacy of intra-operative neurophysiologic monitoring. Journal of Clinical Neurophysics 1995; 12:97-109.
3. Banoub M, Tetzlaff JE, Schubert A. Pharmacolgic and physiologic influences affecting sensory evoked potentials. Anesthesiology 2003; 99:716-37
4 Bromm B, Treede RD. Laser-evoked cerebral potentials in the assessment of cutaneous pain sensitivity in normal subjects and patients. Revue Neurologique (Paris) 1991; 147: 625-43.
5 Samra SK, Dy EA, Welch KB. Remifentanil- and fentanyi-based anesthesia for intraoperative monitoring of somatosensory evoked potentials. Anesth Analg. 2001 Jun; 92(6): 1510-5.
6 Meyer PR, Cotter HB, Gireesan GT. Operative complications resulting from thoracic and lumbar spine internal fixation. Journal of Clinical Orthopedics 1988; 237: 125.
7 Epstein NE, Danto J, Nardi D. Evaluation of intraoperative somatosensory evoked-potential monitoring during 100 cervical operations. Spine 1993; 18: 737.
8 Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologie deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalography and Clinical Neurophsiology 1995; 96: 6-11.
9 Friedman WA. Somatosensory evoked potentials in neurosurgery. Clinical Neurosurgery 1988; 34: 187-238.
10 Debowy DJ, Ghosh S. Comparison of neuronal firing rates in somatosensory and posterior parietal cortex during prehension. Exp Brain Res. 2001; 137(3-4):269-91.
11 陈力学，姜力人，刘宝松等．脑缺血后体感诱发电位和脑电图波谱特征化变化及其与细胞凋亡的关系．中国危重病急救医学2006；18(5)：268-71
12 Moiler AR. Neurophysioiogical monitoring in cranial nerve surgery. Neurosurgery Quarterly 1995; 5: 55-72.
13 Garcia-Larrea L, Artru F, Bertrand O, et al. The combined monitoring of brain stem auditory evoked potentials and intracranial pressure in coma: a study of 57 patients. Journal of Neurology, Neurosurgery and Psychiatry 1992; 55: 792-8.
14 Rumpl E, Prugger M, Gerstenbrand F, et al. Central somatosensory conduction time and acoustic brainstem transmission in post-traumatic coma. Journal of Clinical Neurophysiology 1988; 5: 237-60.
15 Scheufler KM, Reinacher PC, Blumrich W, et al. The modifying effects of stimulation pattern and propofol plasma concentration on motor-evoked potentials. Anesth Analg. 2005 Feb; 100(2):440-7.
16 Roy R, Huang JW. Closed loop intravenous anesthetic administration. Anesthesiology 1997; 87: A641.
17 Mantzaridis H, Kenny GNC. Auditory evoked potential index: a quantitative measure of changes in auditory evoked potentials during general anaesthesia. Anaesthesia 1997; 52:1030-6.
18 Bailey AR, Jones JG. Patients memories of events. Anaesthesia 1997; 52: 460-76.
19 Newton DEF, Thomton C, Konieczko KM, et al. Auditory evoked response and awareness: a study in volunteers at sub-MAC concentrations of isoflurane. British Journal of Anaesthesia 1992; 69: 122-9.
20 Vereecke HE, Vanluchene AL, Mortier EP, et al. The effects of ketamine and rocuronium on the A-Line auditory evoked potential index, Bispectral Index, and spectral entropy monitor during steady state propofol and remifentanil anesthesia. Anesthesiology. 2006; 105(6): 1122-34.
21 Jeffreys JGR, Traub RD, Whittington MA. Neuronal networks for induced '40 Hz' rhythms. Trends in Neuroscience 1996; 19: 202-8.
22 Inoue S, Kawaguchi M. Intraoperative monitoring of myogenic motor-evoked potentials from the external anal sphincter muscle to transcranial electrical stimulation. Spine. 2002 Nov 1; 27(21):E454-9.
23 Plourde G, Boylan JF. The auditory steady-state response during sufentanil anaesthesia. British Journal of Anaesthesia 1991; 66: 683-91.
24 Munglani R, Andrade J, Sapsford DJ, et al. A measure of consciousness and memory during isoflurane administration: the coherent frequency. British Journal of Anaesthesia 1993; 71:633-41.
25 Jeevaratnam RD, Andrade J, Sapsford DJ, et al. The coherent frequency - a measure of cognitive function during sedation. In: Bonke B, Bovill JG, Moerman N, eds. Memory and Awareness in Anaesthesia III. Assen: Van Gorcum, 1996; 197-201.
26 Goodin Douglas S. Event related (endogenous) potentials. In: Aminoff, MJ, ed.Electrodiagnosis in Clinical Neurology, 2nd edn. New York: Churchill Livingstone, 1986; 586-95.
27 Thornton C, Konieczko KM, Knight AB, et al. Effect of propofol on the auditory evoked response and oesophageal contractility. British Journal of Anaesthesia 1989; 63: 411-17.
28 Jessop J, Griffiths DE, Furness P, et al. Changes in amplitude and latency of the auditory evoked potential with sedative and anaesthetic concentrations of nitrous oxide. British Journal of Anaesthesia 1991; 67: 524-31.
29 Tandon OP. P3 event related evoked potential in young adults. Indian Journal of Physiological Pharmacology 1990; 34: 191-4.
30 Stechison MT. Neurophysiologic monitoring during cranial base surgery. Journal of Neuroncology 1994; 20: 313-25.
31 Zaaroor M, Pratt H, Femsod M, et al. Real time monitoring of visual evoked potentials. Israeli Journal of Medical Sciences 1993; 29: 17-22.
32 Cedzich C, Schramm J. Monitoring of flash visual evoked potentials during neurosurgical operations. International Anaesthesiology Clinics 1990; 28: 165-9.
33 Thornton C, Newton DEF. The auditory evoked response: a measure of depth of anaesthesia.Baillieres Clincial Anaesthesiology 1989; 3: 559-85.
34 Schwender D, Klasing S, Madler C, et al. Mid-latency auditory evoked potentials and purposeful movements after thiopentone bolus injection. Anaesthesia 1994; 49: 99-104.
35 Davies FW, Mantzaridis H, Kenny GNC, et al. Middle latency auditory evoked potentials during repeated transitions from consciousness to unconsciousness. Anaesthesia 1996; 51: 107-13.
36 Schwender D, Madler C, Klasing S, et al. Mid-latency auditory evoked potentials and wakefulness during caesarian section. European Journal of Anaesthesiology 1995; 12: 171-9.
37 Schwender D, Daunderer M, Schnatmann N, et al. Midlatency auditory evoked potentials and motor signs of wakefulness during anaesthesia with midazolam. British Journal of Anaesthesia 1997; 79: 53-8.
38 Kumar A, Tandon OP, Dam S, Bhattacharya A, Tyagi KK. Brainstem auditory evoked response changes following electro-acupuncture therapy in chronic pain patients. Anaesthesia 1994; 49:387-90.
39 McGregor RR, Allan LG, Sharpe RM, Thornton C, Newton DEF. Effect of remifentanil on the auditory evoked response and haemodynamic changes after intubation and surgical incision.British Journal of Anaesthesia 1998; 81: 785-6.
40 Brunner MD, Crabb JI, Millett SV, Thornton C, Newton DEF. Alfentanil obtunds the increase in the Pa amplitude associated with intubation in a dose-dependent fashion. Anesthesiology 1995;83:A301.
41 Doi M, Garaj RJ, Mantzaris H, Kenny GNC. Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia:comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. British Journal of Anaesthesia 1997; 78: 180-4.
42 Petersen-Felix S, Arendt-Nielsen L, Bak P, et al. Psychophysical and electrophysiological responses to experimental pain may be influenced by sedation: comparison of a hypnotic (propofol) and an analgesic (alfentanil). British Journal of Anaesthesia 1996; 77: 165-71.
43 Sharpe RM, Nathwani D, Pal SK, et al. Auditory evoked response median frequency and 95% spectral edge during anaesthesia with desflurane and nitrous oxide. British Journal of Anaesthesia 1997; 78: 282-5.
44 Clapcich AJ, Emerson RG, Roye DP Jr, et al. The effects of propofol, small-dose isoflurane,and nitrous oxide on cortical somatosensory evoked potential and bispectral index monitoring in adolescents undergoing spinal fusion. Anesth Analg. 2004;99(5): 1334-40
45 da Costa VV,Saraiva SR,de Almeida AC,et al.The effect of nitrous oxide on the inhibition of somatosensory evoked potentials by sevoflurane in children. Anesthesia 2001;56:202-7
47 Boisseau N.Madany M.Staccini P,et al.Comparison of the effects of sevofluraneand propofol on cortical somatosensory evoked potentials. Br J Anaesth 2002;88: 785-9
48 Svensson P, Arendt-Nielsen L, Bjerring P, Kaaber S. Oral mucosal analgesia quantitatively assessed by argon laser induced thresholds and single evoked vertex potentials. Anesthesia and Pain Control in Dentistry 1993; 2: 154-61.
49 Owen JH. Intraoperative stimulation of the spinal cord for prevention of spinal cord injury.Advances in Neurology 1993; 63: 271.
50 Phillips LHII, Blanco JS, Sussman MD. Direct spinal stimulation for intraoperative monitoring during scoliosis surgery. Muscle and Nerve 1995; 18: 319-25.
51 Deletis V. Intraoperative monitoring of the functional integrity of the motor pathways.Advances in Neurology 1993; 63: 201-14.
52 Sood S, Mahapatra AK, Bhatia R. Somatosesoary and brainstem auditory evoked potential in congnited craniovertebral anomaly: effect of surgical management. Journal of Neurology,Neurosurgery and Psychiatry 1992; 55: 609-12.
53 Apel DM, Marrero G, King J, et al. Avoiding paraplegia during anterior spinal surgery. The role of somatosensory evoked potential monitoring with temporary occlusion of segmental spinal arteries. Spine 1991; 16 (Suppl.): S365.
54 Taniguchi M, Cedzich C, Schramm J. Modification of cortical stimulation for motor evoked potentials under general anaesthesia: technical description. Neurosurgery 1993; 32: 219-26.
55 Madl C, Grimm G, Krammer L, et al. Early prediction of individual outcome after cardiopulmonary resuscitation. Lancet 1993; 341: 855-8.
2. Westergren H, Farooque M, Olsson Y, et al. Spinal cord blood flow changes following systemic hypothermia and spinal cord compression injury: an experimental study in the rat using Laser-Doppler flowmetry. Spinal Cord 2001; 39(2):74-84
3. Kling TF Jr, Wilton N, Hensinger RN, et al. The influence of trimethaphan (Arfonad)-induced hypotension with and without spine distraction on canine spinal cord blood flow. Spine 1986 Apr; 11(3): 219-24
4. Tator CH, Fehlings MG.. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991; 75: 15-26
5．宋福德，詹文林．控制性降压结合单纯血液稀释用于脊椎侧(后)凸矫正术临床观察．临床麻醉学杂志，2000，16：582．
6. Westergren H, Farooque M, Olsson Y, et al. Spinal cord blood flow changes following systemic hypothermia and spinal cord compression injury:an experimental study in the rat using Laser-Doppler flowmetry. Spinal Cord 2001; 39: 74
1. Westergren H, Farooque M, Olsson Y, et al. Spinal cord blood flow changes following systemic hypothermia and spinal cord compression injury:an experimental study in the rat using Laser Dopper flowmetry. Spinal Cord 2001; 39:74-84
2. Padberg AM, Wilson-Holden TJ, Lenke LG, et al. Somatosensory and motor evoked potential monitoring without a wake-up test during idiopathic scoliosis surgery. An accepted standard of care. Spine 1998; 23(12): 1392-1400
3. Charles H. Tator, M. D. Review of the scecondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. Neuro Surg 1991:75:15～26.
4. Richard D, Happel. Ca-accumulation in experimental spinal cord trauma. Brain Res 1981; 211:476～479.
5. Hersey SL, O'Dell NE, Lowe S, et al. Nicardipine versus nitroprusside for controlled hypotension during spinal surgery in adolescent. Anesth Analg 1997; 84:1239-1244
6. Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991; 75:15-26
7. Tymianski M, Tator CH. Normal and abnormal calcium homeostasis in neurons:a basis for the pathophysiology of traumatic and ischemic central nervous system injury. Neurosurgery 1996; 38:1176-95
8．许传清，陈文钊，曹飞等．用诱发电位术中监测脊髓功能的实验研究．临床麻醉学杂志 2002；18：596
1. Westergren H, Farooque M, Olsson Y, et al. Spinal cord blood flow changes following systemic hypothermia and spinal cord compression injury: an experimental study in the rat using Laser-Doppler flowmetry. Spinal Cord 2001;39(2):74-84
2. Mori K, Maeda T, Shiraishi Y, et al. Effects of hypothermia on blood flow and neural activity in rabbit spinal cord during postischemic reperfusion. Jpn J Physiol 2001; 51(1):71-9
3. Krengel WF 3rd, Robinson LR, Schneider VA. Combined effects of compression and hypotension on nerve root function. A clinical case. Spine 1993 Feb; 18(2):306-9
4. Yeoman PM, Gibson M J, Hutchinson A, et al. Influence of induced hypotension and spinal distraction on feline spinal somatosensory evoked potentials. Br J Anaesth 1989 Sep; 63(3):315-20
5. Spargo PM, Tait AR, Knight PR, et al. Effect of nitroglycerine-induced hypotension on canine spinal cord blood flow. Br J Anaesth 1987 May; 59(5):640-7
6. Kling TF Jr, Wilton N, Hensinger RN, et al. The influence of trimethaphan (Arfonad)-induced hypotension with and without spine distraction on canine spinal cord blood flow. Spine 1986 Apr; 11 (3):219-24
1 Pelosi L, Stevenson M, Hobbs GJ. Intraoperative motor evoked potentials to transcranial electrical stimulation during two anaesthetic regimens. Clin Neurophysiol. 2001 Jun; 112(6): 1076-87.
2 Fisher RS, Raudzens P, Nunemacher M. Efficacy of intra-operative neurophysiologic monitoring. Journal of Clinical Neurophysics 1995; 12:97-109.
3. Banoub M, Tetzlaff JE, Schubert A. Pharmacolgic and physiologic influences affecting sensory evoked potentials. Anesthesiology 2003; 99:716-37
4 Bromm B, Treede RD. Laser-evoked cerebral potentials in the assessment of cutaneous pain sensitivity in normal subjects and patients. Revue Neurologique (Paris) 1991; 147: 625-43.
5 Samra SK, Dy EA, Welch KB. Remifentanil- and fentanyi-based anesthesia for intraoperative monitoring of somatosensory evoked potentials. Anesth Analg. 2001 Jun; 92(6): 1510-5.
6 Meyer PR, Cotter HB, Gireesan GT. Operative complications resulting from thoracic and lumbar spine internal fixation. Journal of Clinical Orthopedics 1988; 237: 125.
7 Epstein NE, Danto J, Nardi D. Evaluation of intraoperative somatosensory evoked-potential monitoring during 100 cervical operations. Spine 1993; 18: 737.
8 Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologie deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalography and Clinical Neurophsiology 1995; 96: 6-11.
9 Friedman WA. Somatosensory evoked potentials in neurosurgery. Clinical Neurosurgery 1988; 34: 187-238.
10 Debowy DJ, Ghosh S. Comparison of neuronal firing rates in somatosensory and posterior parietal cortex during prehension. Exp Brain Res. 2001; 137(3-4):269-91.
11 陈力学，姜力人，刘宝松等．脑缺血后体感诱发电位和脑电图波谱特征化变化及其与细胞凋亡的关系．中国危重病急救医学2006；18(5)：268-71
12 Moiler AR. Neurophysioiogical monitoring in cranial nerve surgery. Neurosurgery Quarterly 1995; 5: 55-72.
13 Garcia-Larrea L, Artru F, Bertrand O, et al. The combined monitoring of brain stem auditory evoked potentials and intracranial pressure in coma: a study of 57 patients. Journal of Neurology, Neurosurgery and Psychiatry 1992; 55: 792-8.
14 Rumpl E, Prugger M, Gerstenbrand F, et al. Central somatosensory conduction time and acoustic brainstem transmission in post-traumatic coma. Journal of Clinical Neurophysiology 1988; 5: 237-60.
15 Scheufler KM, Reinacher PC, Blumrich W, et al. The modifying effects of stimulation pattern and propofol plasma concentration on motor-evoked potentials. Anesth Analg. 2005 Feb; 100(2):440-7.
16 Roy R, Huang JW. Closed loop intravenous anesthetic administration. Anesthesiology 1997; 87: A641.
17 Mantzaridis H, Kenny GNC. Auditory evoked potential index: a quantitative measure of changes in auditory evoked potentials during general anaesthesia. Anaesthesia 1997; 52:1030-6.
18 Bailey AR, Jones JG. Patients memories of events. Anaesthesia 1997; 52: 460-76.
19 Newton DEF, Thomton C, Konieczko KM, et al. Auditory evoked response and awareness: a study in volunteers at sub-MAC concentrations of isoflurane. British Journal of Anaesthesia 1992; 69: 122-9.
20 Vereecke HE, Vanluchene AL, Mortier EP, et al. The effects of ketamine and rocuronium on the A-Line auditory evoked potential index, Bispectral Index, and spectral entropy monitor during steady state propofol and remifentanil anesthesia. Anesthesiology. 2006; 105(6): 1122-34.
21 Jeffreys JGR, Traub RD, Whittington MA. Neuronal networks for induced '40 Hz' rhythms. Trends in Neuroscience 1996; 19: 202-8.
22 Inoue S, Kawaguchi M. Intraoperative monitoring of myogenic motor-evoked potentials from the external anal sphincter muscle to transcranial electrical stimulation. Spine. 2002 Nov 1; 27(21):E454-9.
23 Plourde G, Boylan JF. The auditory steady-state response during sufentanil anaesthesia. British Journal of Anaesthesia 1991; 66: 683-91.
24 Munglani R, Andrade J, Sapsford DJ, et al. A measure of consciousness and memory during isoflurane administration: the coherent frequency. British Journal of Anaesthesia 1993; 71:633-41.
25 Jeevaratnam RD, Andrade J, Sapsford DJ, et al. The coherent frequency - a measure of cognitive function during sedation. In: Bonke B, Bovill JG, Moerman N, eds. Memory and Awareness in Anaesthesia III. Assen: Van Gorcum, 1996; 197-201.
26 Goodin Douglas S. Event related (endogenous) potentials. In: Aminoff, MJ, ed.Electrodiagnosis in Clinical Neurology, 2nd edn. New York: Churchill Livingstone, 1986; 586-95.
27 Thornton C, Konieczko KM, Knight AB, et al. Effect of propofol on the auditory evoked response and oesophageal contractility. British Journal of Anaesthesia 1989; 63: 411-17.
28 Jessop J, Griffiths DE, Furness P, et al. Changes in amplitude and latency of the auditory evoked potential with sedative and anaesthetic concentrations of nitrous oxide. British Journal of Anaesthesia 1991; 67: 524-31.
29 Tandon OP. P3 event related evoked potential in young adults. Indian Journal of Physiological Pharmacology 1990; 34: 191-4.
30 Stechison MT. Neurophysiologic monitoring during cranial base surgery. Journal of Neuroncology 1994; 20: 313-25.
31 Zaaroor M, Pratt H, Femsod M, et al. Real time monitoring of visual evoked potentials. Israeli Journal of Medical Sciences 1993; 29: 17-22.
32 Cedzich C, Schramm J. Monitoring of flash visual evoked potentials during neurosurgical operations. International Anaesthesiology Clinics 1990; 28: 165-9.
33 Thornton C, Newton DEF. The auditory evoked response: a measure of depth of anaesthesia.Baillieres Clincial Anaesthesiology 1989; 3: 559-85.
34 Schwender D, Klasing S, Madler C, et al. Mid-latency auditory evoked potentials and purposeful movements after thiopentone bolus injection. Anaesthesia 1994; 49: 99-104.
35 Davies FW, Mantzaridis H, Kenny GNC, et al. Middle latency auditory evoked potentials during repeated transitions from consciousness to unconsciousness. Anaesthesia 1996; 51: 107-13.
36 Schwender D, Madler C, Klasing S, et al. Mid-latency auditory evoked potentials and wakefulness during caesarian section. European Journal of Anaesthesiology 1995; 12: 171-9.
37 Schwender D, Daunderer M, Schnatmann N, et al. Midlatency auditory evoked potentials and motor signs of wakefulness during anaesthesia with midazolam. British Journal of Anaesthesia 1997; 79: 53-8.
38 Kumar A, Tandon OP, Dam S, Bhattacharya A, Tyagi KK. Brainstem auditory evoked response changes following electro-acupuncture therapy in chronic pain patients. Anaesthesia 1994; 49:387-90.
39 McGregor RR, Allan LG, Sharpe RM, Thornton C, Newton DEF. Effect of remifentanil on the auditory evoked response and haemodynamic changes after intubation and surgical incision.British Journal of Anaesthesia 1998; 81: 785-6.
40 Brunner MD, Crabb JI, Millett SV, Thornton C, Newton DEF. Alfentanil obtunds the increase in the Pa amplitude associated with intubation in a dose-dependent fashion. Anesthesiology 1995;83:A301.
41 Doi M, Garaj RJ, Mantzaris H, Kenny GNC. Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia:comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. British Journal of Anaesthesia 1997; 78: 180-4.
42 Petersen-Felix S, Arendt-Nielsen L, Bak P, et al. Psychophysical and electrophysiological responses to experimental pain may be influenced by sedation: comparison of a hypnotic (propofol) and an analgesic (alfentanil). British Journal of Anaesthesia 1996; 77: 165-71.
43 Sharpe RM, Nathwani D, Pal SK, et al. Auditory evoked response median frequency and 95% spectral edge during anaesthesia with desflurane and nitrous oxide. British Journal of Anaesthesia 1997; 78: 282-5.
44 Clapcich AJ, Emerson RG, Roye DP Jr, et al. The effects of propofol, small-dose isoflurane,and nitrous oxide on cortical somatosensory evoked potential and bispectral index monitoring in adolescents undergoing spinal fusion. Anesth Analg. 2004;99(5): 1334-40
45 da Costa VV,Saraiva SR,de Almeida AC,et al.The effect of nitrous oxide on the inhibition of somatosensory evoked potentials by sevoflurane in children. Anesthesia 2001;56:202-7
47 Boisseau N.Madany M.Staccini P,et al.Comparison of the effects of sevofluraneand propofol on cortical somatosensory evoked potentials. Br J Anaesth 2002;88: 785-9
48 Svensson P, Arendt-Nielsen L, Bjerring P, Kaaber S. Oral mucosal analgesia quantitatively assessed by argon laser induced thresholds and single evoked vertex potentials. Anesthesia and Pain Control in Dentistry 1993; 2: 154-61.
49 Owen JH. Intraoperative stimulation of the spinal cord for prevention of spinal cord injury.Advances in Neurology 1993; 63: 271.
50 Phillips LHII, Blanco JS, Sussman MD. Direct spinal stimulation for intraoperative monitoring during scoliosis surgery. Muscle and Nerve 1995; 18: 319-25.
51 Deletis V. Intraoperative monitoring of the functional integrity of the motor pathways.Advances in Neurology 1993; 63: 201-14.
52 Sood S, Mahapatra AK, Bhatia R. Somatosesoary and brainstem auditory evoked potential in congnited craniovertebral anomaly: effect of surgical management. Journal of Neurology,Neurosurgery and Psychiatry 1992; 55: 609-12.
53 Apel DM, Marrero G, King J, et al. Avoiding paraplegia during anterior spinal surgery. The role of somatosensory evoked potential monitoring with temporary occlusion of segmental spinal arteries. Spine 1991; 16 (Suppl.): S365.
54 Taniguchi M, Cedzich C, Schramm J. Modification of cortical stimulation for motor evoked potentials under general anaesthesia: technical description. Neurosurgery 1993; 32: 219-26.
55 Madl C, Grimm G, Krammer L, et al. Early prediction of individual outcome after cardiopulmonary resuscitation. Lancet 1993; 341: 855-8.