Directly measuring spinal cord blood flow and spinal cord perfusion pressure via the collateral network: Correlations with changes in systemic blood pressure
Directly measuring spinal cord blood flow and spinal cord perfusion pressure via the collateral network: Correlations with changes in systemic blood pressure
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DOI：
10.1016/j.jtcvs.2014.09.121
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发表时间：
2015-01-01
影响因子：
6
通讯作者：
Yamashiro, Satoshi
中科院分区：
文献类型：
--
作者：
Kise, Yuya;Kuniyoshi, Yukio;Yamashiro, Satoshi
目的：在胸腹联合手术中，节段动脉被大面积牺牲，侧支网络的血液供应途径作为避免脊髓损伤的一种手段受到关注。本研究的目的是通过直接测量脊髓血流量和脊髓灌注压来研究脊髓通过侧支网络的血液供应。方法：在Beagle犬（n = 8）中，暴露胸腹主动脉和L1-L7段动脉，并建立临时旁路进行远端灌注。接着，将激光血流量计放置在L5区域的硬脊膜上以测量脊髓血流量。当从节段动脉L2-L7到脊髓的直接血液供应停止时，同时测量以下内容：平均全身血压、脊髓灌注压（主动脉夹闭部位内的血压）和通过侧支网络供应的脊髓血流量。结果：在有（r = 0.844，P <0.01）和无（r = 0.834，P <0.01）远端主动脉灌注的节段性动脉血流中断期间，平均体循环血压和脊髓血流量之间呈正相关。此外，我们观察到脊髓灌注压和脊髓血流量之间有显著的相关性，有和没有远端灌注（r = 0.803，P <0.001和r = 0.832，P <0.01），以及有和无远端灌注的平均体循环血压和脊髓灌注压之间（r = 0.898，P < .001和r = 0.837，P < .001）。脊髓从中断的节段动脉外的侧支网络灌注，全身血压升高（类似于1.33倍高）需要获得预夹脊髓血流量，而1.68倍高的全身血压时，远端灌注停止。在夹闭大范围节段动脉造成的脊髓缺血情况下，脊髓血流量与平均体循环血压和脊髓灌注压呈正相关。在开放和血管内胸和胸腹手术中，升高平均体循环血压是增加脊髓血流量的简单有效的方法，并且测量脊髓灌注压似乎对监测围手术期脊髓血流量有用。
Objective: During thoracoabdominal surgery in which segmental arteries are sacrificed over a large area, blood supply routes from collateral networks have received attention as a means of avoiding spinal cord injury. The aim of this study was to investigate spinal cord blood supply through a collateral network by directly measuring spinal cord blood flow and spinal cord perfusion pressure experimentally.Methods: In beagle dogs (n = 8), the thoracoabdominal aorta and segmental arteries L1-L7 were exposed, and a temporary bypass was created for distal perfusion. Next, a laser blood flow meter was placed on the spinal dura mater in the L5 region to measure the spinal cord blood flow. The following were measured simultaneously when the direct blood supply from segmental arteries L2-L7 to the spinal cord was stopped: mean systemic blood pressure, spinal cord perfusion pressure (blood pressure within the aortic clamp site), and spinal cord blood flow supplied via the collateral network. These variables were then investigated for evidence of correlations.Results: Positive correlations were observed between mean systemic blood pressure and spinal cord blood flow during interruption of segmental artery flow both with (r = 0.844, P < .01) and without (r = 0.834, P < .01) distal aortic perfusion. In addition, we observed significant correlations between spinal cord perfusion pressure and spinal cord blood flow with and without distal perfusion (r = 0.803, P < .001 and r = 0.832, P < .01, respectively), and between mean systemic blood pressure and spinal cord perfusion pressure with and without distal perfusion (r = 0.898, P < .001 and r = 0.837, P < .001, respectively). The spinal cord was perfused from the collateral network from outside the interrupted segmental arteries, and high systemic blood pressure (similar to 1.33-fold higher) was needed to obtain the preclamping spinal cord blood flow, whereas 1.68-fold higher systemic blood pressure was needed when distal perfusion was halted.Conclusions: Spinal cord blood flow is positively correlated with mean systemic blood pressure and spinal cord perfusion pressure under spinal cord ischemia caused by clamping a wide range of segmental arteries. In open and endovascular thoracic and thoracoabdominal surgery, elevating mean systemic blood pressure is a simple and effective means of increasing spinal cord blood flow, and measuring spinal cord perfusion pressure seems to be useful for monitoring perioperative spinal cord blood flow.