Svensson L G, Crawford E S, Patel V, McLean T R, Jones J W, DeBakey M E
Department of Surgery, Baylor College of Medicine, Houston, Texas 77030.
Ann Thorac Surg. 1992 Jul;54(1):74-9. doi: 10.1016/0003-4975(92)91143-w.
Similar to other methods of organ preservation, "spinoplegia" may protect the spinal cord from the effects of oxygen desaturation during aortic cross-clamping. In porcine experiments, spinal cord O2 saturation was studied during intraoperative localization of the blood supply to the spinal cord using hydrogen; division of arteries not supplying the spinal cord; aortic cross-clamping for 60 minutes; and 60 minutes after unclamping. In 5 animals, 120 mL of cold saline solution with lidocaine (100 mg/dL) was infused into the aorta during aortic cross-clamping. During sequential localization, O2 saturation dropped by 40.02% (standard deviation, 20.16%) for T-14 artery testing versus a decrease of 17.27% (standard deviation, 11.88%; p = 0.0075) for L-5 artery segment testing in the control animals and returned to baseline thereafter. During aortic cross-clamping maximal O2 desaturation was 5% of baseline (15.7%; p less than 0.0001), which improved slightly by 30 minutes after clamping (48% of baseline +/- 37.37%; p = 0.048 versus maximum) and then returned to baseline (97.1% of baseline +/- 41%) with unclamping; 5 minutes later, hyperoxygenation occurred with a progressive decline thereafter (68% of baseline +/- 29.3%; p = 0.025, 45 minutes after unclamping versus baseline). The decrease in spinal motor evoked potentials was significantly less (p less than 0.02) in the treated group. Intraoperative hydrogen testing in 8 patients was demonstrated to be safe. It accurately localized reattached arteries, and O2 saturation of the spinal cord fell by 56% (standard deviation, 29%; p = 0.0025) with aortic cross-clamping. We conclude that spinal cord ischemia occurs with aortic cross-clamping in both animals and humans.(ABSTRACT TRUNCATED AT 250 WORDS)
与其他器官保存方法类似，“脊髓麻痹”可能会在主动脉交叉钳夹期间保护脊髓免受氧饱和度降低的影响。在猪实验中，在术中使用氢气定位脊髓血供期间、切断不供应脊髓的动脉、主动脉交叉钳夹60分钟以及松开钳夹60分钟后，对脊髓氧饱和度进行了研究。在5只动物中，在主动脉交叉钳夹期间向主动脉内注入120 mL含利多卡因（100 mg/dL）的冷盐水溶液。在连续定位期间，T-14动脉测试时氧饱和度下降了40.02%（标准差为20.16%），而对照组动物L-5动脉节段测试时氧饱和度下降了17.27%（标准差为11.88%；p = 0.0075），之后恢复到基线水平。在主动脉交叉钳夹期间，最大氧饱和度下降至基线的5%（15.7%；p小于0.0001），钳夹30分钟后略有改善（为基线的48%±37.37%；与最大值相比p = 0.048），然后在松开钳夹后恢复到基线（为基线的97.1%±41%）；5分钟后出现高氧血症，此后逐渐下降（为基线的68%±29.3%；p = 0.025，松开钳夹45分钟后与基线相比）。治疗组脊髓运动诱发电位的下降明显较少（p小于0.02）。对8例患者进行的术中氢气测试被证明是安全的。它准确地定位了重新连接的动脉，主动脉交叉钳夹时脊髓氧饱和度下降了56%（标准差为29%；p = 0.0025）。我们得出结论，动物和人类在主动脉交叉钳夹时都会发生脊髓缺血。（摘要截短至250字）
