Diagnosis and Prevention for Spinal Cord Injury using Spinal Cord Plegia and Spinal Cord Cooling Pad during Thoracic Aortic Aneurysm Surgery

为明确胸主动脉瘤致脊髓麻痹的缺血临界时间、诊断肋间动脉的位置及保护脊髓免受缺血性脊髓损伤，本研究采用犬胸主动脉瘤模型，在单纯阻断主动脉的同时，应用诱发脊髓电位，观察冷生理盐水注射对脊髓损伤的保护作用。与单纯阻断主动脉相比，冷盐水注射可迅速降低脊髓电位，减轻脊髓损伤。将异丙酚（神经元保护剂）加入脊髓麻痹中，并观察如何减少单纯主动脉阻断后的脊髓损伤。异丙酚可有效减少主动脉阻断时脊髓损伤。还设计了脊髓冷却垫，并用作脊柱外的冷却器械。脊髓冷却垫能迅速降低脊髓温度，保护脊髓免受缺血性损伤。临床研究中，在胸腹主动脉瘤手术中，将冷血脊髓麻痹液注入夹闭的主动脉。冷注血能迅速降低脊髓诱发电位，并能有效地确定夹闭节段内关键肋间动脉的位置。

This study was scheduled to clarify the critical ischemic time to occur paraplegia during thoracic aortic aneurysm and how to diagnose the site of critical intercostals arteries and protect spinal cord from ischemic spinal cord injury.In animal experiements, efficacy of cold saline (spinal cord plegia) injection into the clamped aortia was investgated using evoked-spinal cord potentials during simple aortic cross clamping in canine model. Cold saline injection revealed prompt decrease of spinal cord potentials and minimized spinal cord injury, comparing with simple aortic cross clamping. Propofol (neuron protective agent) was added to the spinal cord plegia and examined how to decrease spinal cord injury after simple aortic cross clamping. Propofol was effective to decrease spinal cord injury during aortic cross clamping. Spinal cord cooling pad was also devised and used as a cooling instrument outside from the spine. Spinal cord cooling pad decreased spinal cord temperature quickly and protected spinal cord from ischemic injury.In clinical study, cold blood spinal cord plegia was infused into the clamped aorta during thoracoabdominal aortic aneurysm surgeries. Cold blood infusion decreased spinal cord evoked potentials quickly and effective to determine the location of the critical intercostal arteries in the clamped segment.