Ueno T, Furukawa K, Katayama Y, Suda H, Itoh T
Department of Surgery, Saga Medical School, Japan.
Ann Thorac Surg. 1994 Jul;58(1):116-20. doi: 10.1016/0003-4975(94)91083-9.
We present a clinically available method to protect the spinal cord against ischemic or reperfusion injury and to prevent paraplegia after cross-clamping of the aorta. We separated 35 rabbits into five equal groups and clamped each animal's abdominal aorta distal to the left renal artery. We also occluded the aortas 2 cm above the iliac bifurcation for 45 minutes with inflated 5F balloon catheters. Through the catheter port distal to each balloon one of four different solutions was infused at 3 degrees C for 3 minutes at a rate of 5 mL/min (group I, uninfused control; group II, lactated Ringer's solution; group III, lactated Ringer's solution + 30 mg/kg of methylprednisolone; group IV, lactated Ringer's solution+methylprednisolone + 3 mL of 20% mannitol; group V, lactated Ringer's solution+methylprednisolone+mannitol + 10 mg/kg of vitamins E and C). We assessed the neurologic status of the hind limbs on the second postoperative day using Tarlov's criteria. The neurologic status in groups III, IV, and V was significantly superior to that of group I (p < 0.05, groups III versus I; p < 0.01, groups IV and V versus I). Spastic paraplegia occurred in 71% of group I, in 43% of group II, in 29% of group III, in 14% of group IV, and not at all in group V. The infusion of our specially blended solution with several spinal cord neuroprotective properties (hypothermia, methylprednisolone, mannitol, and vitamins E and C) achieved the best spinal cord protection against ischemic or reperfusion injury and prevented postoperative paraplegia.
我们提出了一种临床可行的方法，用于保护脊髓免受缺血或再灌注损伤，并预防主动脉交叉钳夹术后的截瘫。我们将35只兔子分成五组，每组数量相等，并钳夹每只动物左肾动脉远端的腹主动脉。我们还用充气的5F球囊导管在髂总动脉分叉上方2 cm处阻断主动脉45分钟。通过每个球囊远端的导管端口，以5 mL/分钟的速率在3℃下注入四种不同溶液中的一种，持续3分钟（第一组，未注入对照；第二组，乳酸林格液；第三组，乳酸林格液+30 mg/kg甲泼尼龙；第四组，乳酸林格液+甲泼尼龙+3 mL 20%甘露醇；第五组，乳酸林格液+甲泼尼龙+甘露醇+10 mg/kg维生素E和C）。我们在术后第二天使用塔尔洛夫标准评估后肢的神经状态。第三组、第四组和第五组的神经状态明显优于第一组（第三组与第一组相比，p<0.05；第四组和第五组与第一组相比，p<0.01）。第一组71%出现痉挛性截瘫，第二组43%，第三组29%，第四组14%，第五组未出现。输注具有多种脊髓神经保护特性（低温、甲泼尼龙、甘露醇以及维生素E和C）的特殊混合溶液，能实现对脊髓缺血或再灌注损伤的最佳保护，并预防术后截瘫。
