Spinal Ischemia in Thoracic Aortic Procedures: Impact of Radiculomedullary Artery Distribution.
Spinal Ischemia in Thoracic Aortic Procedures: Impact of Radiculomedullary Artery Distribution.
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胸主动脉手术中的脊髓缺血：根髓动脉分布的影响
DOI：
10.1016/j.athoracsur.2017.05.031
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发表时间：
1959
期刊：
影响因子：
--
通讯作者：
Friedhelm
中科院分区：
文献类型：
--
作者：
Fabian A;Wittmann;Krause;Saravi;Puttfarcken;Förster;Katharina;Rylski;Bartosz;Göbel;Ulrich;Matthias;Czerny;Martin;Beyersdorf;Friedhelm
BackgroundThe aim of this study is to assess the influence of thoracic anterior radicalmedullary artery（塔尔马）distribution on spinal cord perfusion in a thoracic aortic surgery model.Methods26只猪（34 ± 3 kg; study group，n = 20; sham group，n = 6）行左锁骨下动脉和胸段动脉结扎。终点为脊髓灌注压（SCPP）、局部脊髓血流量（SCBF）和神经功能结局，观察时间为3小时。检测对终点影响的塔尔马分布模式包括（1）经治疗主动脉段内任何2个tARMA之间的最大距离（0或1段=小距离组; >1段=大距离组）和（2）经治疗主动脉段末端与第一个远端塔尔马之间的距离结果塔尔马的数目为3 ~ 13个（平均8个），其中1个或多个节段的间隙为≥1个。在大距离组中，SCBF从0.48 ± 0.16 mL/g/min降至0.3 ± 0.08 mL/g/min（p< 0.001）。我们在小距离组中未观察到可检测的SCBF下降：从基线时的0.2 ± 0.05 mL/g/min降至钳夹后即刻的0.23 ± 0.05 mL/g/min（p= 0.147）。SCBF仅在小距离组从基线时的0.201 ± 0.055 mL/g/min增加到术后3小时的0.443 ± 0.051 mL/g/min（p< 0.001）。个体阿尔马分布模式沿着治疗的主动脉段可以帮助我们预测脊髓缺血的个体风险。
BackgroundThe aim of this study was to assess the influence of thoracic anterior radiculomedullary artery (tARMA) distribution on spinal cord perfusion in a thoracic aortic surgical model.MethodsTwenty-six pigs (34 ± 3 kg; study group, n = 20; sham group, n = 6) underwent ligation of the left subclavian artery and thoracic segmental arteries. End points were spinal cord perfusion pressure (SCPP), regional spinal cord blood flow (SCBF), and neurologic outcome with an observation time of 3 hours. tARMA distribution patterns tested for an effect on end points included (1) maximum distance between any 2 tARMAs within the treated aortic segment (0 or 1 segment = small-distance group; >1 segment = large-distance group) and (2) distance between the end of the treated aortic segment and the first distal tARMA (at the level of the distal simulated stent-graft end = group 0; gap of 1 or more segments = group ≥1).ResultsThe number of tARMA ranged from 3 to 13 (mean, 8). In the large-distance group, SCBF dropped from 0.48 ± 0.16 mL/g/min to 0.3 ± 0.08 mL/g/min (p< 0.001). We observed no detectable SCBF drop in the small-distance group: 0.2 ± 0.05 mL/g/min at baseline to 0.23 ± 0.05 mL/g/min immediately after clamping (p= 0.147). SCBF increased from 0.201 ± 0.055 mL/g/min at baseline to 0.443 ± 0.051 mL/g/min at 3 hours postoperatively (p< 0.001) only in the small-distance group.ConclusionsWe demonstrate experimental data showing that distribution patterns of tARMAs correlate with the degree of SCBF drop and insufficient reactive parenchymal hyperemia in aortic procedures. Individual ARMA distribution patterns along the treated aortic segment could help us predict the individual risk of spinal ischemia.
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影响因子：
6
作者：
Etz, Christian D.;Kari, Fabian A.;Mueller, Christoph S.;Brenner, Robert M.;Lin, Hung-Mo;Griepp, Randall B.
通讯作者：
Griepp, Randall B.
DOI：
--
发表时间：
1972
期刊：
影响因子：
--
作者：
Mehta Ac
通讯作者：
Mehta Ac
DOI：
10.1053/j.semtcvs.2016.06.004
发表时间：
2016-06-01
影响因子：
2.5
作者：
Kari, Fabian A.;Wittmann, Karin;Beyersdorf, Friedhelm
通讯作者：
Beyersdorf, Friedhelm
自发性气胸：400 例系列。
影响因子：
4.6
作者：
M. Mills;B. Baisch
通讯作者：
B. Baisch
影响因子：
4.1
作者：
LAZORTHES, G;GOUAZE, A;BURDIN, P
通讯作者：
BURDIN, P