论文部分内容阅读
截瘫是胸降主动脉和胸腹主动脉外科手术中严重并发症，实验用兔脊髓缺血模型评价东莨菪碱和氯胺酮的脊髓保护效应。方法２８只兔随机分成４组（每组７只）：对照（Ｃ）组、东莨菪碱（Ｓ）组、氯胺酮（Ｋ）组、东莨菪碱＋氯胺酮（Ｓ＋Ｋ）组。每组肾下主动脉阻断３０ｍｉｎ，动态监测生化指标：乳酸，丙二醛（ＭＤＡ），血栓素Ｂ２（ＴＸＢ２），６酮前列腺素Ｆ１α（６ｋｅｔｏＰＧＦ１α），脊髓血流量（ＳＣＢＦ），后肢运动功能，以及组织水含量与组织学改变。结果再灌注２０ｈ，后肢运动功能Ｓ＋Ｋ组优于Ｃ组（Ｐ＜００５）；脊髓水含量Ｃ组（８０４％±６９％）比Ｓ＋Ｋ组（６９９％＋０６％）增加１０５％（Ｐ＜００１）；组织学改变Ｓ＋Ｋ组最轻，Ｃ组最严重。阻断中Ｓ＋Ｋ组ＭＤＡ浓度较Ｃ组显著下降（Ｐ＜００１），ＳＣＢＦ比值较Ｃ组显著增加（Ｐ＜００１）；开放３０ｍｉｎＳ＋Ｋ组ＭＤＡ、ＴＸＢ２水平较Ｃ组显著下降（Ｐ＜００１与Ｐ＜００５）；缺血２ｈＳ＋Ｋ组与Ｃ组ＭＤＡ与ＳＣＢＦ比值的差别与阻断中相类似。结论Ｓ＋Ｋ组比Ｓ、Ｋ单独应用能更有效地预防脊髓缺血性损伤，推测Ｓ和Ｋ合用可能起到协同作用。
Paraplegia is a serious complication of thoracic ascending aorta and thoracoabdominal aortic surgery. The spinal cord protection effect of scopolamine and ketamine was evaluated using a rabbit spinal cord ischemia model. Methods Twenty-eight rabbits were randomly divided into 4 groups (7 in each group): control group (C), scopolamine group (S), ketamine group (K) and scopolamine + ketamine group (S + K). Each subgroup of renal aorta was blocked for 30 minutes and the biochemical indexes were dynamically monitored: lactic acid, malondialdehyde (MDA), TXB2, 6-keto-prostaglandin F1α (6keto-PGF1α), spinal cord blood flow SCBF), hindlimb motor function, and changes in tissue water content and histology. Results Compared with group C (P <005), the motor function of hind limbs in group S + K was significantly higher than that in group S + K (804% ± 69% vs 699% ± 06% ) Increased by 105% (P <001). Histological changes were the lightest in S + K group and the most severe in C group. The levels of MDA and TXB2 in S + K group were significantly lower than those in C group (P <001) and SCBF ratio (P <001) in C + K group (P < 0 01 and P <0 05). The difference of MDA and SCBF in ischemic 2hS + K group and C group was similar to that in the blockade. Conclusion S + K group is more effective than S and K in preventing ischemic injury of spinal cord. It is speculated that the combination of S and K may play a synergistic effect.