脊髓缺血再灌注损伤过程中的脊髓血流量与组织病理学变化

脊髓缺血再灌注损伤中的脊髓血流量与组织病理学变化的相关性

杨小玉朱庆三刘光耀段德生

吉林大学中日联谊医院骨科长春市仙台大街2号130031

【摘要】目的探讨脊髓缺血再灌流损伤过程中的脊髓血流量与组织病理学变化的关系。方法脊髓缺血再灌注损伤模型建立，通过阻断大鼠腹主动脉造成脊髓腰尾段缺血。按缺血和再灌流各时间段分别阻断开放腹主动脉。应用激光多谱勒血流仪，分别连续测定腰髓血流变化。取缺血前、缺血30分钟、缺血60分钟，缺血30分钟再灌2、4、6、9、12、24h局部脊髓组织进行组织病理和透射电镜检查。结果：在缺血30分钟时腰髓局部血灌流量迅速下降至基线值的-77.51%(P值=2.01E-17) 。再灌流时，局部血流迅速增高并超过基线水平。再灌流10分钟，局部血灌流量与基线的百分比变化值为60.38%(P值=3.3E-7)，随后逐渐降低，再灌流30分钟后，局部血灌流基本恢复基线水平(3.7% P值=0.437899)，以后血流量低于基线水平，出现缺血后延迟低灌流。直至再灌流4小时(-23.5%,P值=1.34E-3)，低灌流保持相对稳定，血流未见恢复。结论再灌注期组织损伤较缺血期严重，且病理学改变程度与再灌流有时间相关性，同时表明再灌流后脊髓发生了二次损伤，脊髓微循环障碍在脊髓缺血再灌注损伤中起重要作用,是脊髓再灌注损伤过程中的重要病理学基础。

【关键词】脊髓缺血再灌注损伤血流激光多普勒血流测定仪组织病理学

Correlation of Histopathology Changes and Spinal Cord Blood Flow in Spinal Cord Ischemical Reperfusion Injury .／Yang Xiaoyu ,ZHU Qing san ,LIU Gingchen, ,LI Yingpu，ZHAO Baollin ,YANG Xiaoyu ,LIN Ye,XING Hongjian orthopedics’department of China-Japanese friendship hospital,，Jilin university Changchun City.130031

【Abstract】Objective:To study the correlation of histopathology changes and spinal cord blood flow after spinal cord ischemical reperfusion injury . Method Model Set-up of ischemic spinal cord injury. Occlusion of the abdominal aorta produces lumbosacral spinal cord ischemia. Abdominal aorta was obstructed and opened according to events of ischemia - referfusion. Laser- Doppler flowmetry was employed to measure hemodynamic changes in the oumbal spinal cord. The lumbo-sacral cord tissue blook was rapidly dissected for the examination of histopathology and transmission electron microscopy according to preichemia, 30 min of ischemia, 60 min of ischemia,and 2, 4, 6, 9h and 12h of reperfusion respectively. Results: The lumbar local SCBF decreased rapidly to – 77.51%(p=2.01E-17), percentage changes of the mean baseline value after 30 min of ischemial. The onset of reperfusion, the SCBF increased rapidly and exceeded the baseline level.The SCBF was 60.38% (p=3.3E-7) of baseline at 10 min of reperfusion. And the local blood perfusion basically recovered baseline level after 30 min of perfusion(3.7% of baseline, p=0.437899). After wards, the SCBF decreased gradually. Up to 4h of reperfusion(-23.5% of baseline, p=1.34E-3) , the SCBF did not return to the baseline level. Conclusion

基金项目：吉林省科学自然基金项目资助（990563-1）

第一作者简介：女（1959－）教授医学博士后，研究方向：脊柱外科基础

电话（0431）－5649255E-mail:yangxiaoyu 88@

Damage of spinal cord tissue in the hypoperfusion phase is serious than its ischemia phase , There are time correlation in the degree of pathology changes and hypoperfusion .At the same time , twice lesion of spinal cord has been occured by spinal cord hypoperfusion. Microcirculation disorder of spinal cord is important base of the pathology.

【Key】Spinal cord Ischemical reperfusion injury Blood flow Laser- doppler flowmetry Histopathology

脊髓损伤(spinal cord injury SCI)一直是困扰医学界的一大难题。临床研究中常见到SCI在解剖上并非完全横断,伤情并不严重,减压后症状有所缓解，但以后发展为“二次瘫痪”。临床上对于SCI 治疗常见于针对缺血恢复血供,而忽视了脊髓再灌注损伤。近二年许多研究表明[1-3]，SCI 后动物双后肢出现二次瘫痪与脊髓组织延迟性低灌流密切相关, 脊髓微循环障碍在脊髓二次损伤中起着重要作用, 因而提出了脊髓存在着缺血再灌注损伤(spinal cord ischemia reperfusion injury I/R),然而,由脊髓再灌注引发的微循环障、病理生理、生化因子参与的脊髓组织进行性、自毁性破坏病理过程仍不十分清楚。因此，本文针对缺血再灌注损伤中脊髓血流量与组织病理学变化进行了动态观察，为临床阻遏脊髓继发性损害提供科学实验依据。

1.材料和方法

1.1脊髓缺血再灌注损伤模型建立：

实验动物分组:Wistar大鼠,体重180-260g,平均220g, 雌雄不限,随机分为正常组、单纯缺血组和缺血再灌组。正常组：(仅麻醉动物不进行阻断血流量)，单纯缺血组:阻断血流30、60min。单纯缺血再灌组：根据所需时间点设计缺血30min后再灌注60min、2、4、6、12、24h组,每组5只鼠，总计40只鼠。