| Autor: |
Cheung A; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada., Streijger F; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada., So K; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada., Okon EB; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada., Manouchehri N; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada., Shortt K; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada., Kim KT; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada.; Department of Neurosurgery, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea., Keung MSM; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada., Chan RM; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada., Fong A; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada., Sun J; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada., Griesdale DE; Department of Anesthesiology, Division of Critical Care Medicine, Vancouver General Hospital, The University of British Columbia, Vancouver, British Columbia, Canada., Sehkon MS; Department of Medicine, Division of Critical Care Medicine, Vancouver General Hospital, The University of British Columbia, Vancouver, British Columbia, Canada., Kwon BK; International Collaboration on Repair Discoveries, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada.; Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada. |
| Abstrakt: |
Current practice guidelines for acute spinal cord injury (SCI) recommend augmenting mean arterial blood pressure (MAP) for the first 7 days post-injury. After SCI, the cord may be compressed by the bone/ligaments of the spinal column, limiting regional spinal cord blood flow. Following surgical decompression, blood flow may be restored, and can potentially promote a "reperfusion" injury. The effects of MAP augmentation on the injured cord during the compressed and decompressed conditions have not been previously characterized. Here, we used our porcine model of SCI to examine the impact of MAP augmentation on blood flow, oxygenation, hydrostatic pressure, metabolism, and intraparenchymal (IP) hemorrhage within the compressed and then subsequently decompressed spinal cord. Yucatan mini-pigs underwent a T10 contusion injury followed by 2 h of sustained compression. MAP augmentation of ∼20 mm Hg was achieved with norepinephrine (NE). Animals received MAP augmentation either during the period of cord compression (CP), after decompression (DCP), or during both periods (CP-DCP). Probes to monitor spinal cord blood flow (SCBF), oxygenation, pressure, and metabolic responses were inserted into the cord parenchyma adjacent to the injury site to measure these responses. The cord was harvested for histological evaluation. MAP augmentation increased SCBF and oxygenation in all groups. In the CP-DCP group, spinal cord pressure steadily increased and histological analysis showed significantly increased hemorrhage in the spinal cord at and near the injury site. MAP augmentation with vasopressors may improve blood flow and reduce ischemia in the injured cord but may also induce undesirable increases in IP pressure and hemorrhage. |
