Simpson J I, Eide T R, Schiff G A, Newman S B, Clagnaz J F, Hossain I, Schulman S B, Gropper J E
Department of Anesthesiology, Long Island Jewish Medical Center, New Hyde Park, New York 11042, USA.
Ann Thorac Surg. 1996 Jan;61(1):113-7. doi: 10.1016/0003-4975(95)00829-2.
Thoracic aortic cross-clamping with the use of sodium nitroprusside (SNP) has been shown to cause a decrease in spinal cord perfusion pressure and an increased incidence of paraplegia. Nitroglycerin is frequently used in this setting. This study investigated the effects of nitroglycerin and SNP on spinal cord ischemia.
Three-groups of 8 mongrel dogs underwent thoracic aortic cross-clamping for 45 minutes. Proximal pressure was maintained between 95 and 100 mm Hg with SNP, nitroglycerin, or phlebotomy. All animals were neurologically evaluated 24 hours later by a blinded observer, and the findings were confirmed by histopathologic study. Statistical analysis (p value of less than 0.05) of measured hemodynamic data was by analysis of variance and of Tarlov scores, the Mann-Whitney U test.
Distal aortic pressures (p < 0.001), Tarlov scores, and spinal cord perfusion pressures (p < 0.01 and p < 0.05 for SNP group and nitroglycerin group, respectively) were significantly higher in the phlebotomy group compared with the SNP and NTG groups. Cerebrospinal fluid pressures were significantly lower in the phlebotomy group compared with the SNP group (p < 0.001).
The use of either NTG or SNP was associated with a high incidence of paraplegia. Nitroglycerin appears to be no safer than SNP when used during thoracic aortic cross-clamping.
已证明使用硝普钠（SNP）进行胸主动脉交叉钳夹会导致脊髓灌注压降低和截瘫发生率增加。硝酸甘油常用于这种情况。本研究调查了硝酸甘油和SNP对脊髓缺血的影响。
将三组8只杂种狗进行胸主动脉交叉钳夹45分钟。分别使用SNP、硝酸甘油或放血使近端压力维持在95至100 mmHg之间。24小时后由一名不知情的观察者对所有动物进行神经学评估，并通过组织病理学研究证实结果。对测量的血流动力学数据进行统计分析（p值小于0.05），采用方差分析和Tarlov评分的Mann-Whitney U检验。
与SNP组和硝酸甘油组相比，放血组的远端主动脉压力（p < 0.001）、Tarlov评分和脊髓灌注压（SNP组和硝酸甘油组分别为p < 0.01和p < 0.05）显著更高。与SNP组相比，放血组的脑脊液压力显著更低（p < 0.001）。
使用硝酸甘油或SNP均与高截瘫发生率相关。在胸主动脉交叉钳夹期间使用时，硝酸甘油似乎并不比SNP更安全。
