硬膜外冷却对脊髓缺血性损伤的防护作用  

Protective effect of epidural cooling upon ischemic spinal cord injury

作　　者：虞建刚[1] 王俊科[1] 熊君宇[1] 崔涌[1] 王昆鹏[1] 孙新艳[1] 

机构地区：[1]中国医科大学第一附属医院麻醉科,沈阳市110001

出　　处：《中华医学杂志》2001年第5期280-282,共3页National Medical Journal of China

摘　　要：目的　研究硬膜外冷却对脊髓缺血性损伤的防护作用。方法　将健康杂种犬 14只随机分为两组 :对照组 8只 ,实验组 6只。将两组犬的胸主动脉双重夹闭 40min造成脊髓缺血。仅对实验组犬在动脉阻断前行硬膜外冷却使脑脊液温度维持于 30℃± 1℃直至主动脉开放后 5min。术后 3d进行后肢神经运动功能评分 (Tarlov评分 )及脊髓组织病理学检查。结果　对照组 8只犬中Tarlov评分 0级 6只 ,其余 2只 1级 ;实验组 6只犬Tarlov评分 4级 4只 ,3级 1只 ,2级 1只 ,其神经运动功能明显好于对照组 (H =10 .6 8,P =0 .0 0 1)。病理学检查显示 ,截瘫犬T10 至S段脊髓灰质出血 ,神经元变性、坏死 ,有髓神经纤维严重脱髓鞘 ,而无截瘫犬脊髓组织学改变轻微。结论　硬膜外冷却所致的脊髓局部低温对犬脊髓缺血性损伤具有明显的保护作用。Objective To evaluate the protective effect of epidural cooling on ischemic spinal cord injury. Methods Fourteen healthy hybrid dogs were randomly divided into two groups: control group (n=8) and experimental group (n=6). Spinal cord injury was induced by double aortic cross-clamping for 40 minutes. Before the clamping, the cerebrospinal fluid temperature of the animals in experimental group was decreased to 30℃±1℃ by epidural cooling until the aorta was unclamped for 5 minutes. Three days after the operation, the function of the hind limbs of the animals was evaluated by Tarlov's scale and histological examination of the spinal cord was made. Results Six dogs showed complete paraplegia (grade 0) and two showed paresis (grade 1) in the control group. The neurological outcome of the experimental group was much better than that in the control group (H=10.68, P=0.001). The neurological function of 4 dogs in the experimental group was in grade 4, and one in grade 3. Histological examination revealed hemorrhage of gray matter, degeneration and necrosis of neurons, and severe demyelination of myelinated nerve fibers in the spinal cord from T10 to sacral segments in dogs with paraplegia. The changes in spinal cord were slight in the dogs without severe neurological injury. Conclusion Local hypothermia of spinal cord by epidural cooling provides effective protection against ischemic spinal cord injury in dog.

关 键 词：脊髓缺血性损伤 硬膜外冷却 防护作用 截瘫 

分 类 号：R651.2[医药卫生—外科学] R683.2[医药卫生—临床医学]