Transrectal intracolon cooling prevents paraplegia and mortality in a rat model of aortic occlusion-induced spinal cord ischemia.
Transrectal intracolon cooling prevents paraplegia and mortality in a rat model of aortic occlusion-induced spinal cord ischemia.
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DOI：
10.1016/j.jvssci.2021.07.003
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Hu B
中科院分区：
文献类型：
--
作者：
Crawford RS;Liu Y;Yuan D;Liu C;Sarkar R;Hu B
脊髓缺血再灌注损伤（SC - IRI）在诸如动脉瘤手术修复等多种医疗情形中均会发生，但临床实践中尚无针对SC - IRI的治疗方法。本研究旨在研发一种用于治疗SC - IRI的新型医疗器械。
研究采用了脊髓缺血再灌注损伤的大鼠模型。研发了一种新型经直肠结肠内（TRIC）体温管理装置，将结肠壁温度维持在37℃（TRIC 37℃组）或12℃（TRIC 12℃组）。两组大鼠的上半身体温均尽可能维持在37℃。通过左侧颈总动脉插入一根2F Fogarty球囊导管，阻断主动脉至脊髓的远端血流。通过颈静脉导管抽血和输血来控制近端血压，使尾动脉远端血压分别维持在约10 mmHg，持续13分钟和20分钟。随后，将球囊放气，在再灌注期间继续使用TRIC体温管理装置30分钟，使结肠壁温度维持在37℃或12℃。
TRIC 37℃组中，所有经历13分钟脊髓缺血的大鼠在缺血后阶段均出现截瘫。与之形成鲜明对比的是，12℃的TRIC完全预防了截瘫的发生，显著改善了动脉血气参数，并避免了经历13分钟脊髓缺血的大鼠脊髓发生组织病理学损伤。此外，TRIC 12℃组可将缺血时间从13分钟延长至20分钟，且功能缺陷明显减轻。
使用TRIC装置对肠道进行局部直接降温，在主动脉阻断诱导的脊髓缺血后，大鼠存活率极高且功能有所改善。
本研究表明，在大鼠主动脉阻断脊髓缺血模型中，使用经直肠结肠内（TRIC）装置直接冷却肠道，对脊髓缺血再灌注损伤具有显著的临床益处，并可防止死亡。本研究的转化价值可能很高，因为其保护效果显著，TRIC装置使用简便，且TRIC冷却带来的不良反应极小。这种新型的TRIC管理方式可在5分钟内将肠道温度从37℃快速降至12℃，同时上半身体温可维持在可耐受的温度范围内，将全身深度冷却的致命不良反应降至最低。
Spinal cord ischemia–reperfusion injury (SC-IRI) occurs in many medical conditions such as aneurysm surgical repair but no treatment of SC-IRI is available in clinical practice. The objective of the present study was to develop a novel medical device for the treatment of SC-IRI. A rat model of SC-IRI was used. A novel transrectal intracolon (TRIC) temperature management device was developed to maintain an intracolon wall temperature at either 37°C (TRIC37°C) or 12°C (TRIC12°C). The upper body temperature was maintained as close as possible to 37°C in both groups. A 2F Fogarty balloon catheter was inserted via the left common carotid artery to block the distal aortic blood flow to the spinal cord. The proximal blood pressure was controlled by the withdrawal and infusion of blood via the jugular vein catheter, such that the distal tail artery blood pressure was maintained at ∼10 mmHg for 13 and 20 minutes, respectively. Next, the balloon was deflated, and TRIC temperature management was continued for an additional 30 minutes to maintain the colon wall temperature at either 37°C or 12°C during the reperfusion period. All the rats subjected to 13 minutes of spinal cord ischemia in the TRIC37°C group had developed paraplegia during the postischemic phase. In striking contrast, TRIC at 12°C completely prevented the paraplegia, dramatically improved the arterial blood gas parameters, and avoided the histopathologic injuries to the spinal cord in rats subjected to 13 minutes of spinal cord ischemia. Furthermore, TRIC12°C allowed for the extension of the ischemia duration from 13 minutes to 20 minutes, with significantly reduced functional deficits. Directly cooling the intestine focally with the TRIC device offered an exceptional survival rate and functional improvement after aortic occlusion-induced spinal cord ischemia. The present study showed that the use of the transrectal intracolon (TRIC) device to directly cool the intestine offers outstanding clinical benefits against spinal cord ischemia–reperfusion injury and prevents mortality in the rat aortic occlusion spinal cord ischemia model. The translational value of the present study could be high because the protection was so dramatic, the TRIC device is easy to use, and the TRIC cooling adverse effects were minimal. This novel TRIC management modality can offer fast cooling of the gut from 37°C to 12°C within 5 minutes, and the upper body temperature can be maintained in a tolerable temperature range, minimizing the fatal adverse effects of whole-body deep cooling.