Seibel P S, Theodore P, Kron I L, Tribble C G
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908.
J Vasc Surg. 1993 Aug;18(2):153-8; discussion 158-60.
Operations on the thoracic and thoracoabdominal aorta are associated with postoperative paraplegia rates as high as 20% to 30%. Attempts to reduce this complication have focused on decreasing the energy needs of the spinal cord with protective agents such as hypothermia and barbiturates or on increasing blood flow with various shunts. This study explores the hypothesis that perfusion of the spinal cord with hypothermic solutions or with adenosine will prevent or ameliorate paraplegia.
New Zealand white rabbits underwent 40 minutes of infrarenal aortic isolation. The infrarenal aorta is the primary source of spinal cord blood supply in the New Zealand white rabbit. Control rabbits sustained aortic occlusion without any protective measures. The remaining animals were randomized into three groups that underwent aortic cross-clamping with various protective adjuncts. Group I received regional aortic hypothermia perfusion, group II received systemic adenosine, and group III received regional aortic perfusion with high-dose adenosine.
Neurologic function was graded according to the Tarlov scale (0 = no movement, 1 = slight movement, 2 = sits with assistance, 3 = sits alone, 4 = weak hop, 5 = normal hop). After 96 hours animals were euthanized, and spinal cords were harvested for histologic examination. The nonparaplegic animals in group I had a mean Tarlov score of 1.5, whereas those in group III had a mean score of 3.4. Histologic studies on spinal cord tissue revealed no significant differences between the study groups.
These data demonstrate that administration of regional adenosine attenuates ischemic injury associated with aortic occlusion in this experimental model.
胸主动脉和胸腹主动脉手术的术后截瘫发生率高达20%至30%。为降低这一并发症，人们致力于使用低温和巴比妥酸盐等保护剂降低脊髓的能量需求，或通过各种分流术增加血流量。本研究探讨如下假说：用低温溶液或腺苷灌注脊髓可预防或减轻截瘫。
新西兰白兔接受40分钟肾下主动脉分离。肾下主动脉是新西兰白兔脊髓血液供应的主要来源。对照组兔子在无任何保护措施的情况下维持主动脉闭塞。其余动物随机分为三组，接受不同保护辅助措施的主动脉交叉钳夹术。第一组接受局部主动脉低温灌注，第二组接受全身腺苷治疗，第三组接受高剂量腺苷局部主动脉灌注。
根据塔尔洛夫量表对神经功能进行分级（0 = 无运动，1 = 轻微运动，2 = 需辅助坐立，3 = 独自坐立，4 = 弱跳，5 = 正常跳跃）。96小时后对动物实施安乐死，并取出脊髓进行组织学检查。第一组未发生截瘫的动物塔尔洛夫平均评分为1.5，而第三组为3.4。脊髓组织学研究显示各研究组之间无显著差异。
这些数据表明，在该实验模型中，局部给予腺苷可减轻与主动脉闭塞相关的缺血性损伤。
