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  • 简介:Objective:Toidentifyandseparatetheventralrootfromdorsalroot,whichisthekeyforsuccessoftheartificialsomatic-autonomicreflexpathwayprocedureforneurogenicbladderafterspinalcordinjury(SCI).Herewereporttheresultsofintra-operatingroommonitoringwith10paralyzedpatients.Methods:TenmalevolunteerswithcompletesuprasacralSCIunderwenttheartificialsomatic-autonomicprocedureundergeneralanesthesia.Vastusmedialis,tibialisanticusandgastrocnemiusmedialisoftheleftlowerlimbweremonitoredforelectromyogram(EMG)activitiesresultedfromL4,L5,andS1stimulationrespectivelytodifferentiatetheventralrootfromdorsalroot.ALaborieUrodynamicssystemwasconnectedwithathreechannelurodynamiccatheterinsertedintothebladder.TheL2andL3rootswerestimulatedseparatelywhiletheintravesicalpressurewasmonitoredtoevaluatethefunctionofeachroot.Results:Thethresholdsofstimulationonventralrootwere0.02msduration,0.2-0.4mA,(mean0.3mA±0.07mA),comparedwith0.2-0.4msduration,1.5-3mA(mean2.3mA±0.5mA)fordorsalroot(P<0.01)tocauserevokedpotentialsandEMG.ElectricalstimulationonL4rootsresultedintheEMGbeingrecordedmainlyonvastusmedialis,whilestimulationonL5orS1rootscausedelectricalactivitiesoftibialisanticusorgastrocnemiusmedialisrespectively.Thecontinuousstimulationforabout3-5secondsonS2orS3ventralroot(0.02ms,20Hz,and0.4mA)couldresultedinbladderdetrusorcontraction,butthestrongestbladdercontractionover50cmH2OwasusuallycausedbystimulationonS3ventralrootin7ofthe10patients.Conclusions:Intra-operatingroomelectrophysiologicalmonitoringisofgreathelptoidentifyandseparateventralrootfromdorsalroot,andtoselecttheappropriatesacralventralrootforbestbladderreinnervation.Differentparametersandthresholdsondifferentrootsarethemostimportantfactorstokeepinmindtoavoiddamagingtherootsandtoassurethebestresu

  • 标签: 电生理学 神经系统损伤 机体反应 膀胱损伤
  • 简介:Objective: Toexploretheregulationofearlybraintissuemetabolicchangingafterbraininjuriesandtheclinicalsignificance.  Methods: Therewere17patientswithbraininjuries.EarlydirectmonitoringofPtiO2,PtiCO2,pHandbraintemperature,dynamicobservationoftherelationbetweenvariousparametersandclinicsafterbraininjurieswereperformed.  Results: EarlychangesofPtiO2,PtiCO2andpHwerecloselycorrelatedwithoutcome.ThedeathrateobviouslyincreasedwhenPtiO2wascontinuouslylowerthan9mm?Hgwithin24hoursafterinjuries.Secondarybraininjuryprolongedandaggravatedbraintissuemetabolicdisturbance.Whenintracerebralpressurewasover30mm?HgPtiO2begantodecrease.Thebraintemperatureinbraindeathpatientswasevidentlylowerthanaxillarytemperature.  Conclusions: ThedirectmonitoringofPtiO2,PtiCO2,pHandbraintemperatureissafeandaccurateandcanfindearlyanoxiadamagetobraintissueandprovidereliablebasisforclinicaltherapy.Ithasaninstructivesignificanceinselectingandstudyinganewtreatmentmethodinbraininjuries.Anditcanbetakenasacriterioninclinicaljudgingbraindeaths.

  • 标签: 脑损伤 脑组织 监测