脊髓及神经根缺血再灌注损伤机制及中药防治作用的研究进展

Research progress on mechanism of spinal cord and nerve root ischemia-reperfusion injury and prevention and treatment of traditional Chinese medicine

脊髓缺血再灌注损伤是脊柱减压手术或胸腹主动脉手术严重并发症之一,一旦出现则会引起脊髓、神经功能障碍、下肢瘫痪等严重后果。由于其复杂的发生机制,尽管目前的治疗措施包括高压氧、脊髓缺血预处理等在内的防治手段,但仍无法从根本上阻断脊髓缺血再灌注损伤的发展。在临床上,脊柱减压术后也常出现神经根继发性损伤。通过调研大量文献,梳理并总结脊髓缺血再灌注损伤的发生发展过程中可能的生理病理机制,包括氧化应激、炎症反应、细胞凋亡及离子过载等,并类比脊髓的缺血再灌注损伤,提出了神经根缺血再灌注损伤的概念。通过梳理临床上应用的补气活血类中药,揭示中药通过多成分、多途径、多靶点发挥协同治疗作用优势及其抗氧化、抗炎、抑制细胞过度凋亡、干预钙过载等方面作用机制,以期拓展脊髓及神经根缺血再灌注损伤研究的基础机制和科学用药,为中药的临床诊疗提供全面的依据和新思路。

Spinal cord ischemia-reperfusion injury is one of the serious complications of spinal decompression surgery or thoracic and abdominal aortic surgery.Once it occurs,it will cause serious consequences such as spinal cord and nerve dysfunction and lower limb paralysis.Due to its complex occurrence mechanism,the current treatment measures,including hyperbaric oxygen,spinal cord ischemia preconditioning,and other means of prevention and treatment,are still unable to fundamentally block the development of spinal cord ischemia-reperfusion injury.In clinical practice,secondary nerve root injuries often occur after spinal decompression surgery.Based on this phenomenon,this paper screened and summarized the possible physiological and pathological mechanisms in the development of spinal cord ischemia-reperfusion injury,including oxidative stress,inflammation,apoptosis,and ion overload,and puts forward the concept of nerve root ischemia-reperfusion injury by analogy with spinal cord ischemia-reperfusion injury through the investigation of a large number of literatures.By combing the clinically applied qi and blood tonifying traditional Chinese medicine,we revealed the synergistic therapeutic advantages of traditional Chinese medicine through multi-components,multi-pathways,and multi-targets,as well as their mechanisms of action in terms of antioxidant,anti-inflammatory,inhibition of excessive apoptosis,and intervention of calcium overload,hopefully to expand the basic mechanisms and scientific use of medicines in the study of spinal cord and nerve root ischemia/reperfusion injury,and to provide a comprehensive basis and a new way of thinking for clinical diagnosis and treatment of traditional Chinese medicine.