Spinal cord blood flow and ischemic injury after experimental sacrifice of thoracic and abdominal segmental arteries
Spinal cord blood flow and ischemic injury after experimental sacrifice of thoracic and abdominal segmental arteries
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DOI：
10.1016/j.ejcts.2008.01.069
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发表时间：
2008-06-01
影响因子：
3.4
通讯作者：
Griepp, Randall B.
中科院分区：
文献类型：
--
作者：
Etz, Christian D.;Homann, Tobias M.;Griepp, Randall B.
目的：胸腹主动脉瘤(TAAA)修补术中牺牲胸腹主动脉节段动脉(TAASA)后脊髓血流量(SCBF)的变化尚不清楚。本研究探讨了AT(TAASA)动物处死后72小时的SCBF。方法：对14头幼年约克夏猪(T4~L5)进行连续完整的TAASA处死。6头对照猪麻醉后降温至32℃，不牺牲TAASA。用运动诱发电位(MEPs)连续监测实验动物脊髓功能，直到夹闭最后一根TAASA后1h。荧光微球可在完全断奶前、断头后5分钟、1小时、5小时、24小时和72小时沿整个脊髓节段测量SCBF。术后3d行改良Tarlov评分。结果：所有TAASA完全处死的猪在TAASA结扎后1英寸内均能保持正常的脊髓功能(MEP)。7头(50%)完全断奶后72小时恢复正常，7头出现截瘫或截瘫。术中至术后1小时，三组间的SCBF沿整个脐带方向相似。对照组和恢复期动物术后5h出现明显充血，而T8-L2段和B-S段出现截瘫或截瘫(p=0.0002)和B-S段(p=0.0007)。在24 h时，SCBF在尾侧仍略低于T8；在72 h时，整个脊髓的SCBF在所有组中都是相似的。预测功能恢复时T8-L2节段的SCBF为5(p=0.003)。结论：本研究提示，TAASA完全牺牲后严重的脊髓缺血不会立即发生(术中)，而是在夹闭后延迟1-5h或更长时间，代表未能对复温和苏醒产生充血反应。与脊髓损伤相关的TOW SCBF持续时间较短，提示仅持续24-72小时的血流动力学和代谢操作可能允许常规保存正常的脊髓功能，尽管手术或血管内修复大的TAAA继发性地牺牲了AT[TAASA]。(C)2008年欧洲胸心外科协会。爱思唯尔出版，版权所有。
Objective: Spinal cord blood flow (SCBF) after sacrifice of thoracoabdominal aortic segmental arteries (TAASA) during thoracoabdominal aortic aneurysm (TAAA) repair remains poorly understood. This study explored SCBF for 72 h after sacrifice of at( TAASA. Methods: Fourteen juvenile Yorkshire pigs underwent complete serial TAASA sacrifice (T4-L5). Six control pigs underwent anesthesia and cooling to 32 degrees C with no TAASA sacrifice. In the experimental animals, spinal cord function was continuously monitored using motor evoked potentials (MEPs) until 1 h after clamping the last TAASA. Fluorescent microspheres enabled segmental measurement of SCBF along the entire spinal cord before, and 5 min, 1 h, 5 h, 24 h and 72 h after complete TAASA sacrifice. A modified Tarlov score was obtained for 3 days after surgery. Results: All the pigs with complete TAASA sacrifice retained normal cord function (MEP) until 1 In after TAASA ligation. Seven pigs (50%) with complete TAASA sacrifice recovered after 72 h; seven pigs suffered paraparesis or paraplegia. Intraoperatively, and until I h postoperatively, SCBF was similar among the three groups along the entire cord. Postoperatively, SCBF did not decrease in any group, but significant hyperemia occurred at 5 h in controls and recovery animals, but did not occur in pigs that developed paraparesis or paraplegia in the T8-L2 segments (p = 0.0002) and B-S segments (p = 0.0007). At 24 h, SCBF remained marginally Lower from T8 caudally; at 72 h, SCBF was similar among all groups along the entire cord. SCBF in the segments T8-L2 at 5 In predicted functional recovery (p = 0.003). Conclusions: This study suggests that critical spinal cord ischemia after complete TAASA sacrifice does not occur immediately (intraoperatively), but is delayed 1-5 h or longer after clamping, and represents failure to mount a hyperemic response to rewarming and awakening. The short duration of tow SCBF associated with spinal cord injury suggests that hemodynamic and metabolic manipulation lasting only 24-72 h may allow routine preservation of normal cord function despite sacrifice of at[ TAASA secondary to surgical or endovascular repair of large TAAA. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. ALL rights reserved.