Department of Biological Sciences, National Sun Yat-sen University, No. 70, Lien-Hai Rd., Kaohsiung city 804, Taiwan; Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung city 807, Taiwan.
Department of Biological Sciences, National Sun Yat-sen University, No. 70, Lien-Hai Rd., Kaohsiung city 804, Taiwan.
Spine J. 2024 Oct;24(10):1964-1980. doi: 10.1016/j.spinee.2024.04.023. Epub 2024 Apr 27.
Cervical spinal cord injury usually results in cardiorespiratory dysfunctions due to interruptions of the bulbospinal pathways innervating the cervical phrenic motoneurons and thoracic sympathetic preganglionic neurons.
The present study aimed to evaluate the therapeutic effects of adrenergic agents on systemic and spinal hemodynamics during acute cervical spinal cord injury.
In vivo animal study.
The cardiorespiratory function and spinal cord blood flow and oxygenation level were monitored in response to cervical spinal cord contusion and intravenous infusion of three types of adrenergic agents (phenylephrine, dobutamine, and norepinephrine).
Cervical spinal cord contusion resulted in immediate reduction of respiratory airflow, arterial blood pressure, and spinal cord blood flow. The arterial blood pressure and spinal cord blood flow remained lower than the preinjury value in contused animals infused with saline at 60 min postinjury. Infusion of phenylephrine (500, 1000, and 2000 μg/kg) and norepinephrine (125, 250, and 500 μg/kg) significantly increased the arterial blood pressure, while only norepinephrine augmented the spinal cord blood flow. Conversely, dobutamine (1000 and 2000 μg/kg) reduced both arterial blood pressure and spinal cord blood flow. Notably, administration of adrenergic agents tended to increase spinal cord hemorrhage in contused animals.
Infusion of norepinephrine can effectively maintain the blood pressure and improve spinal cord blood flow during acute spinal cord injury.
Norepinephrine may be a superior medicine for hemodynamic management; however, the potential hemorrhage should be considered when utilizing the vasopressor to regulate systemic and spinal hemodynamics at the acute injured stage.
颈脊髓损伤通常会导致心肺功能障碍，这是由于支配颈膈运动神经元和胸交感节前神经元的球脊通路中断所致。
本研究旨在评估肾上腺素能药物在急性颈脊髓损伤时对全身和脊髓血液动力学的治疗作用。
体内动物研究。
监测心肺功能以及脊髓血流和氧合水平，以响应颈脊髓挫伤和三种类型的肾上腺素能药物（苯肾上腺素、多巴酚丁胺和去甲肾上腺素）的静脉输注。
颈脊髓挫伤导致呼吸气流、动脉血压和脊髓血流立即减少。在受伤后 60 分钟用生理盐水输注的挫伤动物中，动脉血压和脊髓血流仍低于损伤前值。输注苯肾上腺素（500、1000 和 2000μg/kg）和去甲肾上腺素（125、250 和 500μg/kg）显著增加了动脉血压，而只有去甲肾上腺素增加了脊髓血流。相反，多巴酚丁胺（1000 和 2000μg/kg）降低了动脉血压和脊髓血流。值得注意的是，肾上腺素能药物的给药倾向于增加挫伤动物的脊髓出血。
输注去甲肾上腺素可有效维持血压并改善急性脊髓损伤时的脊髓血流。
去甲肾上腺素可能是一种用于血液动力学管理的较好药物；然而，在利用血管加压素来调节全身和脊髓血液动力学的急性损伤阶段时，应考虑潜在的出血。
