猪深低温停循环辅助灌注脑保护机制的研究  

The study of cerebral protective mechanism in pigs with deep hyperthermia circulatory arrest under long-term window

作　　者：董斌[1] 罗其中[2] 江基尧[2] 邱永明[2] 钟春龙[2] 徐英辉[1] 廉治刚[1] 陆兆丰[2] 

机构地区：[1]大连医科大学附属第一医院神经外科,116011 [2]上海第二医科大学附属仁济医院神经外科

出　　处：《中国脑血管病杂志》2004年第11期507-510,共4页Chinese Journal of Cerebrovascular Diseases

基　　金：上海市科委科技发展基金(004119025)

摘　　要：目的研究深低温停循环(DHCA)长程时间窗90 min期间行间歇性一侧颈动脉顺行辅助灌注脑保护液(IUACP)的脑保护作用。方法将10-15kg实验小猪22只,分为三组:空白对照组6只,18℃不停循环90 min,不加灌注脑保护液;阳性对照组8只,18℃停循环90 min,不加灌注脑保护液;实验组8只,18℃停循环90min,IUACP灌注1,6-二磷酸果糖+氧和冷晶液脑保护液。采用改良开胸体外循环法建立猪DHCA模型,转流降温至鼻咽温18℃时停循环90 min,分别在停循环期间、降温和复温时加用脑保护液间歇灌注,观察各组动物的脑血流量、生理指标变化、神经血红蛋白的表达和电镜下海马组织神经元的超微结构变化。 结果实验组脑血流量在IUACP辅助下由(22.2±2.5)ml·min-1·100g-1上升到(38.5±2.6)ml·min-1·100g-1。空白对照组检测到少量神经元形态学改变,阳性对照组可以观察到严重的神经元损害,电镜下发现海马CA1区线粒体肿胀,而实验组线粒体形态正常,突触有大量囊泡聚集,逆转录聚合酶链反应神经血红蛋白表达上调,c-FOS蛋白表达增加。结论 1,6-二磷酸果糖+氧和冷晶液是一种较好的脑保护液,DHCA 90 min内IUACP有较好的脑保护作用;深低温下的氧耐受可能源于神经血红蛋白有较好的携氧保护脑的作用。Objective To evaluate the cerebral protective role of IUACP during DHCA with long-term window (90 min) and to prolong the arrest time during DHCA with the aid of IUACP method. Methods Pigs (10 - 15 kg) underwent cooling on modified cardiopulmonary bypass (CPB) to 18℃. In the animals of group 1 ( n = 6), CPB was maintained in a state of deep hypothermia(18℃) for 90 min without arrest. Group 2 ( n = 8) underwent 90 min arrest of DHCA at 18℃. Group 3 ( n = 8) underwent 90min arrest of DHCA at 18℃ with IUACP. IUACP was performed in the period of cooling, arrest time, and rewarming after CPB. The RT-PCR expression of Ngb, the western expression of c-fos, the cerebral blood volume (CBV) and other physiological conditions were examined. The CA1 region morphology of the hippocampus were examined by electron microscopy. Results The CBV of group 3 was (38. 5 ±2. 6) ml · min-1-1 · 100g-1, which was greater than that of group 2. Little morphological change was observed in group 1 and group 2. The expression of Ngb and c-fos was up regulated in group 1 and group 3. Otherwise, the mitochondrion of group 2 was swelling and denaturized under electron microscopy, and the expression of c-fos and Ngb had no change. Conclusion IUACP plays an effectively protective role in long-term DHCA; FDP in oxygenated crystal liquid can be used for cerebral protection with IUACP under DHCA; Ngb may be related to oxygen transfer under long-term DHCA, and can protect brain from being lack of oxygen.

关 键 词：脑保护液 灌注 辅助 深低温停循环 DHCA 血红蛋白 表达 下海 目的 

分 类 号：R654.1[医药卫生—外科学]