Yamada T, Morimoto T, Nakase H, Hirabayashi H, Hiramatsu K, Sakaki T
Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
Neurosurgery. 1998 Mar;42(3):626-34. doi: 10.1097/00006123-199803000-00033.
The goal was to study the hemodynamics and regional pathophysiological changes in the spinal cord after transient vascular occlusion in cats.
We measured spinal cord blood flow (SCBF) continuously in the lumbar region with a laser-doppler flowmeter, before, during, and after spinal cord ischemia induced by balloon occlusion of the thoracic aorta, in 24 cats (divided into three groups) and simultaneously recorded the evoked spinal cord potentials (ESPs). In each group (n = 8), 10-, 20-, and 30-minute ischemic loading was performed. All animals were evaluated neurologically 36 hours later, and then their spinal cords were examined histologically.
The amplitude of ESPs decreased 10 minutes and disappeared 20 minutes after occlusion. SCBF increased to as much as 2 times the control values after reperfusion and decreased gradually in all groups. Then, in all animals in the 10-minute group and six animals in the 20-minute group, SCBF returned to the control values, which were subsequently maintained throughout the experiment, and ESPs returned to normal patterns within 1 hour. For all animals in the 30-minute group and two in the 20-minute group, hypoperfusion after recirculation, irreversible amplitude changes in ESPs, postischemic paraparesis, and pathological ischemic changes in the lower thoracic and lumbar spinal segments were recognized.
Our results showed that > 20-minute occlusion of the thoracic aorta in cats resulted in irreversible spinal perfusion disorders and that the monitoring of SCBF and ESPs could be useful for predicting potential neurological deficits. Furthermore, postischemic hypoperfusion may have an important role in the development of secondary spinal cord ischemia, resulting in severe neurological dysfunction. This observation suggested the possibility of therapeutic modification of the secondary processes inducing hypoperfusion after spinal ischemia.
研究猫短暂性血管闭塞后脊髓的血流动力学及局部病理生理变化。
我们用激光多普勒血流仪连续测量24只猫(分为三组)胸主动脉球囊闭塞诱导脊髓缺血前、缺血期间及缺血后的腰段脊髓血流量(SCBF),并同时记录脊髓诱发电位(ESPs)。每组(n = 8)进行10、20和30分钟的缺血负荷。36小时后对所有动物进行神经学评估,然后对其脊髓进行组织学检查。
闭塞后10分钟ESPs波幅降低,20分钟时消失。再灌注后SCBF增加至对照值的2倍,并在所有组中逐渐下降。然后,10分钟组的所有动物及20分钟组的6只动物,SCBF恢复至对照值,随后在整个实验过程中保持稳定,ESPs在1小时内恢复正常模式。30分钟组的所有动物及20分钟组的2只动物,再灌注后出现灌注不足、ESPs波幅不可逆变化、缺血后轻瘫以及胸段下部和腰段脊髓节段的病理性缺血改变。
我们的结果表明,猫胸主动脉闭塞> 20分钟会导致不可逆的脊髓灌注障碍,监测SCBF和ESPs有助于预测潜在的神经功能缺损。此外,缺血后灌注不足可能在继发性脊髓缺血的发展中起重要作用,导致严重的神经功能障碍。这一观察结果提示了对脊髓缺血后诱导灌注不足的继发过程进行治疗性干预的可能性。