Use of Neuroanesthesia Adjuncts (Hyperventilation and Mannitol Administration) Improves Neurological Outcome After Thoracic Aortic Cross‐Clamping in Dogs
Use of Neuroanesthesia Adjuncts (Hyperventilation and Mannitol Administration) Improves Neurological Outcome After Thoracic Aortic Cross‐Clamping in Dogs
复制标题
使用神经麻醉辅助剂（过度换气和甘露醇给药）可改善狗胸主动脉交叉钳夹后的神经系统结果
DOI：
10.1161/01.str.24.8.1204
复制
发表时间：
1993
期刊：
影响因子：
8.3
通讯作者：
L. Girling
中科院分区：
文献类型：
--
作者：
W. A. Mutch;M. R. Graham;W. Halliday;D. Thiessen;L. Girling
背景与目的通过犬胸主动脉交叉夹持模型，我们比较了在使用和不使用标准神经麻醉辅助（甘露醇和故意过度通气）时截瘫的发生率和严重程度。用甘露醇和过度通气治疗的动物预后较好。方法19只犬（平均±SD体重，21±3kg）用甲氧六醇麻醉，记录等电脑电图。将动物随机分为C组（对照组，n=9）和M组（甘露醇和故意过度通气，n=10）。C组维持正常的血氧浓度（PaCO2, 38 ~ 42 mm Hg）。在M组，动物过度通气至PaCO2 28 ~ 32 mm Hg，手术准备时给予甘露醇2 g kg−1，然后持续输注1 g kg−1 h−1。交叉夹胸主动脉30分钟。在(1)基线、(2)交叉夹后2分钟、(3)交叉夹后20分钟、(4)交叉夹解除后5分钟、(5)复苏后30分钟测量全身血流动力学、脑脊液压和动脉血气。两组均未尝试控制交叉夹紧的血流动力学后果。解除交叉钳后，C组PaCO2不受控制；M组进一步增加分气量，维持PaCO2恒定。在交叉夹持后24小时，由一名不知道实验方案的观察者使用塔洛夫评分评估动物截瘫的发生率和严重程度。这些动物被杀死，整个脊髓被切除以进行组织学评估。多段腰椎脊髓经苏木精和伊红染色处理。结果应用交叉钳后，两组脑脊液压和中心静脉压均明显升高。然而，在M组中，最大平均脑脊液压从未超过c组的基线值。在交叉钳释放后，M组脊髓灌注压（远端平均主动脉压减平均脑脊液压）显著高于M组（86±23 vs 65±17 mm Hg；组间P= 0.0017）。M组维持酸碱平衡较好，截瘫发生率和严重程度显著低于M组（P= 0.043； Mann-Whitney秩和检验，双尾）。在这一组中，10只动物中有10只可以行走，10只动物中有4只完全康复。C组9只动物4只截瘫。通过光镜评估，Tarlov评分与腰椎区前脊髓神经元死亡与总神经元数量之比呈显著负相关（P= 0.0004； Spearman秩检验）。我们得出结论，使用标准神经麻醉辅助剂（甘露醇和故意过度通气）的方案与甲氧己酮麻醉犬胸主动脉交叉夹持30分钟后神经系统预后改善有关。
Background and Purpose Using a canine model of thoracic aortic cross-clamping, we compared the incidence and severity of paraplegia with and without standard neuroanesthesia adjuncts (mannitol administration and deliberate hyperventilation). Better outcome was predicted for animals treated with mannitol and hyperventilation. Methods Nineteen dogs (mean±SD weight, 21±3 kg) were anesthetized with methohexital to an isoelectric electroencephalogram. Animals were randomized to group C (control; n=9) or group M (mannitol administration and deliberate hyperventilation; n=10). In group C, animals were maintained normocapnic (PaCO2, 38 to 42 mm Hg). In group M, animals were hyperventilated to a PaCO2 of 28 to 32 mm Hg and received mannitol 2 g kg−1 during surgical preparation, then 1 g kg−1 h−1 by continuous infusion. The thoracic aorta was cross-clamped for 30 minutes. Systemic hemodynamics, cerebrospinal fluid pressure, and arterial blood gases were measured at (1) baseline, (2) 2 minutes after cross-clamp, (3) 20 minutes after cross-clamp, (4) 5 minutes after cross-clamp release, and (5) 30 minutes after resuscitation. No attempt was made to control the hemodynamic consequences of cross-clamping in either group. With release of the cross-clamp, PaCO2 was not controlled in group C; in group M the minute ventilation was further increased to maintain PaCO2 constant. At precisely 24 hours after cross-clamp the animals were assessed for incidence and severity of paraplegia, using the Tarlov score, by an observer unaware of the experimental protocol. The animals were killed, and the entire spinal cord was removed for histological assessment. Multiple sections of the lumbar spinal cord were processed and stained with hematoxylin and eosin. Results With application of the cross-clamp, cerebrospinal fluid pressure and central venous pressure increased significantly in both groups. However, in group M the maximal mean cerebrospinal fluid pressure never exceeded baseline values in group C. With cross-clamp release, spinal cord perfusion pressure (distal mean aortic pressure minus mean cerebrospinal fluid pressure) was significantly greater in group M (86±23 vs 65±17 mm Hg; P=.0017 between groups). Acid-base balance was better maintained in group M. The incidence and severity of paraplegia were significantly lower in group M (P=.043; Mann-Whitney rank-sums test, two-tailed). In this group 10 of 10 animals could walk and 4 of 10 had complete recovery. In group C 4 of 9 animals were paraplegic. There was a strong negative correlation between the Tarlov score and the ratio of dead to total anterior spinal cord neurons in the lumbar region as assessed by light microscopy (P=.0004; Spearman's rank test). Conclusions We conclude that a protocol using standard neuroanesthesia adjuncts (mannitol administration and deliberate hyperventilation) is associated with improved neurological outcome after thoracic aortic cross-clamping of 30 minutes' duration in dogs anesthetized with methohexital.
甘露醇对大鼠暂时性完全性脑缺血后局部脑血流的影响。
影响因子：
4.1
作者：
Shirane,R;Weinstein,PR
通讯作者：
Weinstein,PR