Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented?
Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented?
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DOI：
10.1016/j.ejcts.2007.01.023
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发表时间：
2007-04-01
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：了解椎旁吻合网络提供足够脊髓灌注压（SCPP）的能力，这对于胸腹主动脉瘤（TAAA）的手术和腔内修复至关重要。研究方法：为了监测侧支循环中的压力，将导管插入10只幼年约克郡猪（28.9 +/-3.8 kg）的分开的第一腰段动脉（SA）的远端。在32 ℃下连续处死从T3到L5的SA对;使用运动诱发电位（MEP）连续监测SCPP和功能，直到夹紧最后一个SA后1小时。术后5天继续进行间歇性主动脉和SCPP监测，沿着运动功能评价。结果如下：平均14.4 +/- 0.7个SA被处死，没有丢弃MER SSCP（mmHg）从SA夹闭前的68 +/- 7（主动脉压的77%）降至夹闭结束时的22 6，1小时后降至21 4，5小时后达到最低点19 +/- 4 -。术后，SCPP在24 h恢复至33 +/- 6; 48 h恢复至42 +/- 10; 72 h恢复至56 +/- 14; 96 h恢复至62 +/- 15，120 h恢复至基线（63 +/- 20）。尽管SCPP模式相似，但4头猪没有完全恢复站立能力。6头猪恢复了站立能力：2头可以站立，4头可以行走。结论：在该猪模型中，在32 ℃下中断所有SA导致脊髓损伤谱，术后大多数猪的功能正常。两次SCPP的持续时间短表明，尽管牺牲了所有SA，但仅24-48小时的血流动力学操作可能允许常规完全保留正常脊髓功能。(c)2007年欧洲胸外科协会。Elsevier B. V.出版，保留所有权利。
Objective: Understanding the ability of the paraspinal anastomotic network to provide adequate spinal cord perfusion pressure (SCPP) critical for both surgical and endovascular repair of thoracoabdominal aortic aneurysms (TAAA). Methods: To monitor pressure in the collateral circulation, a catheter was inserted into the distal end of the divided first lumbar segmental artery (SA) of 10 juvenile Yorkshire pigs (28.9 +/- 3.8 kg). SA pairs from T3 through L5 were serially sacrificed at 32 degrees C; SCPP and function - using motor-evoked potentials (MEPs) - were continuously monitored until 1 h after clamping the last SA. Intermittent aortic and SCPP monitoring was continued for 5 days postoperatively, along with evaluation of motor function. Results: A mean of 14.4 +/- 0.7 SAs were sacrificed without toss of MER SCPP (mmHg) dropped from 68 +/- 7 before SA clamping (77% of aortic pressure) to 22 6 at end clamping, and 21 4 after 1 h, reaching its lowest point 19 +/- 4 - after 5 h. Postoperatively, SCPP recovered to 33 +/- 6 at 24 h; 42 +/- 10 at 48 h; 56 +/- 14 at 72 h; 62 +/- 15 at 96 h, returning to baseline (63 +/- 20) at 120 h. Despite comparable SCPP patterns, four pigs did not fully regain the ability to stand. Six animals recovered: two could stand and four could walk. Conclusions: Interruption of all SAs at 32 degrees C in this pig model results in a spectrum of cord injury, with normal function in a majority of pigs postoperatively. The short duration of tow SCPP suggests that hemodynamic manipulation tasting only 24-48 h may allow routine complete preservation of normal cord function despite sacrifice of all SAs. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.