选择性深低温阻断猴脑血流对脑干功能和形态的影响  

The effects of selective cerebral profound hypothermia on the morphology and functions of brain stem in monkey

作　　者：高永军[1] 徐蔚[1] 冯忠堂[2] 江基尧[3] 付登礼[1] 曹毅[1] 唐一平[1] 

机构地区：[1]云南省昆明医学院第二附属医院神经外科,650101 [2]云南省昆明医学院神经科学研究所 [3]上海第二医科大学附属仁济医院神经外科

出　　处：《中国现代神经疾病杂志》2005年第1期40-44,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：教育部科学技术研究重点项目(02141);云南省自然科学基金重点项目(2003C0010Z);云南省自然科学基金资助项目(2002C0052M);上海市科委基础研究重点项目(03JC14038)

摘　　要：目的探讨在选择性深低温(<20℃)条件下,阻断猴脑双侧颈内动脉血流60min后实验动物复苏的可能性及对生命体征、重要内脏器官功能、脑干功能以及脑干形态学的影响。方法分离双侧颈内动、静脉,颈外静脉和腹股沟动、静脉。于右侧颈内动脉插管冷灌注和同侧颈内静脉插管回流静脉血,阻断双侧颈外静脉和左侧颈内动、静脉血流建立脑局部体外循环,通过腹股沟动、静脉插管监测平均动脉压和中心静脉压,根据二者的变化调整冷灌注和静脉血回流的速度。观察脑温变化过程中生命体征的改变,降温前后分析血液生化指标的变化,动物复苏后取脑干行组织病理学检查。结果7只猴均完成选择性深低温阻断脑血流60min实验,其中5只安全复苏。当脑温由37℃降至34.5℃时,出现血压和心率的短暂性增高,随后降低。在深低温期间应用血管活性药物可以维持平均动脉压及心率的稳定,脑温恢复后生命体征逐渐平稳。在血流阻断前后脑干功能无明显变化。血常规(除外白细胞计数)、蛋白质、碱性磷酸酶和胆碱脂酶等项指标在深低温阻断血流前后的变化,差异具有显著性意义(P<0.05或P<0.01);其余各项指标如白细胞计数、转氨酶类、乳酸脱氢酶、肌酸激酶、三酰甘油以及电解质等指标的变化差异无显著性意义(P>0.05)。降温过程中。Objective To study the possibility of resuscitation and effect on vital signs, important visceral organ functions, function and morphology of brain stem in experimental monkey with occluding bilateral internal carotid arteries for 60 min under selective cerebral profound hypothermia (< 20 ℃). Methods Bilateral internal carotid arteries and veins, external jugular veins and inguinal arteries and veins were separated. The right internal carotid artery and vein were intubated for cold perfusion and refluxing venous blood, then the local extracorporeal circulation of brain was established after occlusion of bilateral external jugular veins and left internal carotid artery and vein. The mean arterial and central venous pressures were monitored through cannula in inguinal artery and vein. The velocity of cold perfusion and venous blood reflux were modulated according to the changes of both pressures mentioned above. The vital signs during brain temperature changes were monitored and blood biochemical change pre and post temperature lowering were analyzed. The histopathological examination of brain stem was performed after resuscitation. Results Five monkeys resuscitated safely after cerebral profound hypothermia occlusion of blood flow in 60 min among 7 experimental monkeys. A transient increasing of blood pressure and heart rate was found during lowering cerebral temperature from 37 ℃ to 34.5 ℃, then it was decreasing afterwards. The administration of vasoactive drug during profound hypothermia might maintain the stability of mean arterial pressure and heart rate. The vital signs were getting stable after restoring of cerebral temperature. Pre and post blood occlusion no significant change of brain stem functions but significant changes (P < 0.05 or P < 0.01) of blood routine (except WBC count), protein, alkaline phosphatase and cholinesterase parameters were found. There were no significant difference (P > 0.05) in changing of the following parameters eg. WBC count, transaminases, lactic dehydrogena

关 键 词：深低温 阻断 脑干功能 双侧 生命体征 颈内动脉 脑温 脑血流 复苏 颈外静脉 

分 类 号：R742.89[医药卫生—神经病学与精神病学]