猪深低温停循环长程时间窗脑保护机制研究  

Mechanism of cerebral protection under long-term window in the pig with deep hyperthermia circulatory arrest

作　　者：董斌[1] 徐英辉[1] 罗其中[2] 江基尧[2] 邱永明[2] 钟春龙[2] 廉治刚[1] 陆兆丰[2] 王以政[3] 

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 [3]中科院上海生命科学院神经所信号转导组

出　　处：《中华神经外科杂志》2004年第6期467-470,共4页Chinese Journal of Neurosurgery

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长程时间窗90min行间歇性一侧颈动脉顺行灌注脑保护液的辅助脑保护作用。方法实验小猪(10～15kg)22只分三组:空白对照组6只,18℃不停循环90min,不加灌注脑保护液;阳性对照组8只,18℃停循环90min,不加脑保护液灌注;实验组8只,18℃停循环90min一侧颈动脉顺行灌注保护液。采用改良开胸体外循环法建立猪深低温模型,转流降温至鼻咽温18℃时停循环90min,分别在停循环期间、降温和复温时加用脑保护液间歇灌注,观察停循环长程时间窗及辅助灌注的脑血流量和生理指标变化、神经血红蛋白(Neuroglobin,Ngb)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辅助灌注下由(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,阳性对照组电镜下可以观察到神经元线粒体明显肿胀,而实验组线粒体形态正常,突触有大量囊泡聚集,RT-PCR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;停循环90min内辅助灌注有较好的脑保护作用;深低温下的氧耐受可能源于Ngb有较好的携氧脑保护作用。Objective The study was undertaken to evaluate the cerebral protective role of IUACP during DHCA with long-term window(90 min). Methods 22Pigs(10～15kg) underwent cooling on modified cardiopulmonary bypass to 18℃.In group 1(n=6),CPB was maintained in a state of deep hypothermia(18℃) for 90 min without arrest. Group 2 animals (n=8)underwent 90 min arrest time of DHCA at 18℃,and group 3 (n=8)underwent 90min of DHCA using IUACP at 18℃. IUACP was performed in the period of cooling, arrest time,and rewarming after CPB. The RT-PCR expression of Ngb and the western expression of c-fos,and the cerebral blood volume and other physiological conditions were examined. What'more,the CA1 region morphology of the hippocampi were examined by electron microscopy. Results The BFV of IUACP increased to(38.5±2.6)ml.min-1.100g-1, which was greater than that of group2. Little morphological change was observed in group 1 and group 3. The expression of Ngb and c-fos was upregulated in group 1 and group 3. Otherwise,the mitochondrion of group 2 showed swelling and denaturation under electron microscopy, and the expression of c-fos and Ngb had no change. Conclusion IUACP had a effectively protective role in FDP in oxygeonated crystal liquid had better cerebral protection long-term DHCA;with IUACP under DHCA; Ngb had a close concerning with oxygeon transfer under long-term DHCA,and can protect brain from beinglack-of oxygeon lesion.

关 键 词：灌注 脑保护液 辅助 脑保护作用 深低温停循环 时间窗 表达 结论 实验 上升 

分 类 号：R651[医药卫生—外科学]