局部亚低温人工脑脊液灌洗对脊髓缺血/再灌注损伤的影响  

Effect of Focal Irrigation with Mild Hypothermic Artificial Cerebral Spinal Fluid on the Spinal Ischemia/Reperfusion Injury

作　　者：唐昱英[1] 林严俊[2] 李吉满[3] 黄蔚[1] 万俊峰[3] 罗南富[2] 

机构地区：[1]四川大学华西第二医院麻醉科,成都610041 [2]四川大学华西医院麻醉科,成都610041 [3]四川省肿瘤医院病理科,成都610041

出　　处：《四川大学学报（医学版）》2010年第6期970-974,共5页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨局部亚低温人工脑脊液灌洗对脊髓缺血／再灌注损伤的影响。方法成年健康雄性新西兰大白兔18只，随机分为3组：正常对照组（NC组），脊髓缺血／再灌注组（SIR组）和局部亚低温人工脑脊液灌洗组（FI组）。SIR组和FI组采用肾下腹主动脉阻断法建立脊髓缺血／再灌注模型。FI组在腹主动脉阻断时即以30mL／h的速度持续从L4-5蛛网膜下腔泵入25℃的人工脑脊液，同时从L7—8蛛网膜下腔开放引流脑脊液。60min后开放腹主动脉的同时停止人工脑脊液灌洗。持续记录腹主动脉阻断期间和开放后30min的直接动脉压和脑脊液压力变化，观察术后72h的神经行为学和脊髓组织病理学变化。结果NC组在整个实验期间平均动脉压和脑脊液压力基本平稳。SIR组和FI组在实验期间平均动脉压变化趋势相似，均在主动脉阻断时平均动脉压迅速下降，并于主动脉阻断后30min和开放后30min内持续低于NC组和基础水平（P〈0．05）。SIR组在主动脉阻断时脑脊液压力迅速升高，并于主动脉阻断后10min持续升高直达峰值，随后缓慢下降并逐渐趋于稳定。但在整个实验过程中SIR组的脑脊液压力均高于NC组和基础水平（P〈0．05）。FI组在主动脉阻断时脑脊液压力迅速下降至3．8mmHg（1mmHg=0．1333kPa），并在术中持续稳定在3～5mmHg，低于NC组和基础水平（P〈0．05），并于开放后20min逐渐向正常水平恢复。FI组的术后神经功能评分和脊髓组织病理学改变优于SIR组但仍次于NC组。结论局部亚低温人工脑脊液灌洗可降低脊髓缺血／再灌注期问的脑脊液压力，并对脊髓缺血／再灌注损伤具有一定的保护作用。Objective To investigate the effect of focal irrigation with mild hypothermic artificial cerebral spinal fluid on the spinal ischemia/reperfusion injury. Methods Eighteen health male New Zealand white rabbits were randomly divided into three groups., normal control group （Group NC）, spinal ischemia-reperfusion group （Group SIR） and focal irrigation with mild hypothermic artificial cerebral spinal fluid group （Group FI）. The rabbits in Group SIR and Group FI were subjected to spinal ischemia/reperlusion injury by clamping the infrarenal abdominal aorta. The rabbits in Group FI received focal irrigation with 25 ℃ artificial cerebral spinal fluid during the spinal ischemia period. The mean arterial pressure （MAP） and cerebral spinal fluid pressure （CSFP） were continuously measured during the ischemic/reperfusion processes. The neurological conditions of the rabbits were assessed at 24 h, 48 h and 72 h after reperfusions. The spinal cords were harvested 72 h after reperfusions for histological analysis. Results The MAP and CSFP in Group NC remained stable. The MAP in Group SIR and Group FI decreased continuously in the first 30 min of spinal ischemia period and 30 min after reperfusion. The CSFP in Group SIR increased continuously in the first 10 min of spinal ischemia and was higher than the baseline and those in Group NC. The CSFP in Group FI decreased to 3.8 mmHg （1 mmHg=0. 1333 kPa） at the beginning of spinal ischemia, and remained at 3-5 mmHg until 20 min after reperfusions. Group FI had better neurological outcomes and less severe pathological changes than Group SIR measured at 72 h after ischemia/reperfusion. Conclusion Focal irrigation with mild hypothermic artificial cerebral spinal fluid can decrease CSFP during spinal ischemia/reperfusion and protect spinal cords against ischemia/reperfusion injuries.

关 键 词：亚低温 人工脑脊液灌洗 脊髓缺血/再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]