Department of Surgery, Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado.
Department of Surgery, Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado.
Semin Thorac Cardiovasc Surg. 2019;31(4):713-720. doi: 10.1053/j.semtcvs.2019.02.025. Epub 2019 Feb 27.
This article summarizes the anatomically driven pathophysiology of spinal cord injury, the impact of ischemia reperfusion on the cellular level, current research in developing neuronal ischemic tolerance, and promotion of collateralization. It addresses neuroprotective strategies in modern clinical practice, current pharmacologic interventions, and continued challenges in the management of complex aortic disease. The pathophysiology of spinal cord injury includes disruption and recovery of collateral blood flow and the effects of malperfusion on the spinal cord. The optimal approach to spinal cord protection is to employ an integrated and protocolized set of strategies to simultaneously maximize spinal cord blood flow, improve ischemic tolerance, and promote collateralization. In the laboratory setting, investigation should continue to pursue a more granular understanding of ischemic injury and seek to translate protective therapies to clinical practice.
本文总结了脊髓损伤的解剖驱动病理生理学、缺血再灌注对细胞水平的影响、目前在开发神经元耐缺血性方面的研究，以及促进侧支循环。它涉及现代临床实践中的神经保护策略、当前的药物干预以及复杂主动脉疾病管理中的持续挑战。脊髓损伤的病理生理学包括侧支血流的中断和恢复，以及灌注不良对脊髓的影响。保护脊髓的最佳方法是采用综合和规范化的策略集，同时最大限度地提高脊髓血流量，提高耐缺血性，并促进侧支循环。在实验室环境中，应继续深入研究缺血性损伤，并寻求将保护疗法转化为临床实践。
