颈内静脉压迫：一种减轻爆炸所致听力损伤的新方法。

Internal Jugular Vein Compression: A Novel Approach to Mitigate Blast Induced Hearing Injury.

作者信息

Sindelar Brian, Shinners Michael, Sherman Sydney, Novak Kevin, Erickson Kristine, Patel Vimal, Kubilis Paul, Smith David, Finan John, Bailes Julian E

机构信息

*Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois †Department of Neurosurgery, University of Florida, Gainesville, Florida ‡Department of Surgery, Division of Otolaryngology §Department of Neurophysiology, NorthShore University HealthSystem, Evanston, Illinois ||Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

出版信息

Otol Neurotol. 2017 Apr;38(4):591-598. doi: 10.1097/MAO.0000000000001332.

DOI:10.1097/MAO.0000000000001332

PMID:28079681

Abstract

HYPOTHESIS

Internal jugular vein (IJV) compression before blast injury will lead to reduced risk of traumatic hearing injury following exposure to a blast injury.

BACKGROUND

IJV compression and its effects on not only intracranial, but also intracochlear pressure may potentiate blast induced hearing injury, therefore, precluding its use as a prophylactic therapy for blast induced traumatic brain injury.

METHODS

Twenty Sprague Dawley rats were exposed to a 17.9 ± 0.4 PSI (195.8 dB SPL) right sided shock wave in which 10 had application of a custom IJV compression collar before injury. All rodents received baseline and post blast injury otoacoustic emission (OAE) and auditory brainstem response (ABR) testing followed by cochlear histology.

RESULTS

IJV compression was shown to significantly reduce ABR and OAE threshold shifts in comparison to the non-intervention group by: 14.9 ± 4.8 dB (right ear ABR 0.5 kHz Day 1 post blast, p = 0.01), 13.1 ± 4.9 dB (right ear ABR 4 kHz Day 1 post blast, p = 0.04), 16.5 ± 4.5 dB (right ear ABR click Day 1 post blast, p = 0.003), 12.1 ± 4.6 dB (right ear ABR click Day 6 post blast, p = 0.04), and 14.0 ± 3.2 dB (both ears OAE 3.2-10 kHz, p < 0.0001). Also, those animals with collar application had a greater number of total hair cells per mm from 70 to 100% distance from the cochlear apex following blast injury in comparison to those without intervention (blast: 211.8 ± 27.5 versus blast+collar: 355.5 ± 39.5 [p = 0.0002]).

CONCLUSION

This study supports the use of IJV compression in a pre-clinical model as a new prophylactic mechanism to combat blast induced hearing injury.

摘要

假设

爆炸伤前压迫颈内静脉（IJV）将降低暴露于爆炸伤后发生创伤性听力损伤的风险。

背景

压迫颈内静脉不仅对颅内压，而且对耳蜗内压力都有影响，这可能会加重爆炸引起的听力损伤，因此，不能将其用作爆炸引起的创伤性脑损伤的预防性治疗方法。

方法

20只Sprague Dawley大鼠暴露于17.9±0.4磅力/平方英寸（195.8分贝声压级）的右侧冲击波中，其中10只在受伤前使用定制的颈内静脉压迫项圈。所有啮齿动物在爆炸伤前后均接受了耳声发射（OAE）和听性脑干反应（ABR）测试，随后进行耳蜗组织学检查。

结果

与未干预组相比，压迫颈内静脉可显著降低ABR和OAE阈值偏移：14.9±4.8分贝（爆炸后第1天右耳ABR 0.5千赫兹，p = 0.01），13.1±4.9分贝（爆炸后第1天右耳ABR 4千赫兹，p = 0.04），16.5±4.5分贝（爆炸后第1天右耳ABR短声，p = 0.003），12.1±4.6分贝（爆炸后第6天右耳ABR短声，p = 0.04），以及14.0±3.2分贝（双耳OAE 3.2 - 10千赫兹，p < 0.0001）。此外，与未干预的动物相比，佩戴项圈的动物在爆炸伤后，从耳蜗顶端70%到100%距离处每毫米的总毛细胞数量更多（爆炸伤：211.8±27.5对爆炸伤 + 项圈：355.5±39.5 [p = 0.0002]）。