Tavşan modelinde spinal iskemi reperfüzyon hasarının azaltılmasında N-Asetil Sistein'in etkinliği
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Date
2008
Authors
Çökünlü, Özgür
Journal Title
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Publisher
Uludağ Üniversitesi
Abstract
Aort cerrahisinde spinal kord iskemisi, anestezi ve cerrahi tekniklerdeki gelişmelere rağmen önemli bir sorun olmaya devam etmektedir. İskemi reperfüzyon hasarının etkilerini azaltmak amacıyla çeşitli farmakolojik ajanlarla ilgili pek çok çalışmaya rağmen rutin kullanıma giren bir farmakolojik ajan bulunmamaktadır. Bu çalışmada amaç, Glutatyon prekürsörü olan ve süpürücü antioksidan etkisi bilinen N-Asetil sistein'in tavşan modelinde iskemik spinal kord hasarı üzerine olan etkisini incelemektir.Yeni Zelanda türü 30 tavşan randomize olarak her birinde altı tavşan olacak şekilde beş gruba ayrıldı. Grup 0 (G0) da herhangi bir cerrahi girişim yapılmadı. Grup 1 (G1) de abdominal aorta 20 dakika süre ile klemplendi. Grup 2 (G2) de klemp süresi 40 dakika idi. Grup 3 (G3) de abdominal aorta 20 dakika, Grup 4 (G4) de 40 dakika süre ile klemplendi. G3 ve G4 deki deneklere klemp öncesi tek doz 50 mg/kg N-Asetil sistein (NAC) intravenöz olarak verildi. Cerrahi girişimden 48 saat sonra Modifiye Tarlov skorlamasına göre nörolojik durumları değerlendirilen denekler sakrifiye edildiler. Deneklerin spinal kordlarının L3-L6 segmentleri histopatolojik değerlendirme için çıkarıldı.Cerrahi girişim yapılmayan grupta nörolojik defisit gelişmedi. İstatistiksel olarak anlamlı olmamakla birlikte en yüksek tarlov skoru ortalaması Grup 3'de saptandı. Yine Grup 3'de 2 denekte herhangi bir nörolojik defisit gelişmezken 1 denekte minimal nörolojik defisit gelişti. Aksonal ödem, inflamatuar yanıt ve hücresel hasar için yapılan skorlamalarda da en düşük skor ortalamaları yine Grup 3'de saptandı.Çalışmamızda N-Asetil sistein (NAC) ın normotermik deneklerde spinal kord iskemi-reperfüyonu sonrası ortaya çıkan hücresel hasarı ve nörolojik defisiti önlemede etkinliği gösterilemedi.
Spinal cord ischemia in aortic surgery keeps going to important issue despite progress in anesthesia and sugical technics. Despite a lot of studies on several pharmacologic agents to decrease effects of ischemia-reperfusion injury, there is no a pharmacological agent that in use as rutin. Purpose in this study to investigate the effect of N-acetylcysteine which is glutathion precursor and has scavenger antioxidant feature on ischemic spinal cord injury in rabbit model. Thirty New Zeland rabbits were randomly divided into five groups which each had six rabbits. In Group 0 (G0) any surgical intervention was not performed. In Group 1 (G1) abdominal aorta was clamped over 20 minutes. The clamp time was 40 minutes in Group 2 (2). In Group 3 (G3) abdominal aorta was clamped over 20 minutes and in Group 4 (G4) 40 minutes. Fifty mg/kg N-acetylcystein was administered to subjects in G3 and G4 before the clamping by intravenous route. After 48 hours from surgical intervention subjects were sacrified which had been neurologic status evaluated with Modified Tarlov scoring. L3-L6 segments of spinal cords that belonging to subjects were removed for histopathologic evaluation.Neurologic deficit was not developed in surgical intervention free group. The highest mean of Tarlov score was observed in Group 3 even though it was not significant statistically. Again group 3 while any neurologic deficit didn't develop in 2 subjects, minimal deficit developed in 1 subject. In the scoring to axonal edema, inflammatory response and cellular damage the minimum score means were also observed in group 3.In our study, it was not be able to shown that NAC has efficiency to prevent cellular damage and neurologic deficit appearing after ischemia-reperfusion in subjects in normothermia.
Spinal cord ischemia in aortic surgery keeps going to important issue despite progress in anesthesia and sugical technics. Despite a lot of studies on several pharmacologic agents to decrease effects of ischemia-reperfusion injury, there is no a pharmacological agent that in use as rutin. Purpose in this study to investigate the effect of N-acetylcysteine which is glutathion precursor and has scavenger antioxidant feature on ischemic spinal cord injury in rabbit model. Thirty New Zeland rabbits were randomly divided into five groups which each had six rabbits. In Group 0 (G0) any surgical intervention was not performed. In Group 1 (G1) abdominal aorta was clamped over 20 minutes. The clamp time was 40 minutes in Group 2 (2). In Group 3 (G3) abdominal aorta was clamped over 20 minutes and in Group 4 (G4) 40 minutes. Fifty mg/kg N-acetylcystein was administered to subjects in G3 and G4 before the clamping by intravenous route. After 48 hours from surgical intervention subjects were sacrified which had been neurologic status evaluated with Modified Tarlov scoring. L3-L6 segments of spinal cords that belonging to subjects were removed for histopathologic evaluation.Neurologic deficit was not developed in surgical intervention free group. The highest mean of Tarlov score was observed in Group 3 even though it was not significant statistically. Again group 3 while any neurologic deficit didn't develop in 2 subjects, minimal deficit developed in 1 subject. In the scoring to axonal edema, inflammatory response and cellular damage the minimum score means were also observed in group 3.In our study, it was not be able to shown that NAC has efficiency to prevent cellular damage and neurologic deficit appearing after ischemia-reperfusion in subjects in normothermia.
Description
Keywords
N-Asetil sistein, Spinal kord, Reperfüzyon, Parapleji, İskemi, N-Acetylcystein, Spinal cord, Ischemia, Reperfusion, Paraplegia
Citation
Çökünlü, Ö. (2008). Tavşan modelinde spinal iskemi reperfüzyon hasarının azaltılmasında N-Asetil Sistein'in etkinliği. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.