迷走神经刺激对致痫动物的抗痫作用  

Effect of stellate ganglion block on cerebral blood velocity

作　　者：赵兰峰[1] 李菁锦[1] 安仰原[1] 王毅珍[2] 

机构地区：[1]首都医科大学神经生物学系,北京市100069 [2]北京天坛医院神经内科,北京市100050

出　　处：《中国临床康复》2006年第18期182-183,186,共3页Chinese Journal of Clinical Rehabilitation

基　　金：北京市教委基金资助课题（00KJ-1998）

摘　　要：背景：迷走神经刺激术是一种治疗难治性癫痫的神经生理学疗法，通过刺激颈部迷走神经干可达到控制癫痫发作的目的。 目的：观察间断性左侧迷走神经刺激术对致痫动物痫性发作的影响，为躯体内脏信息相互作用提供理论根据。 设计：观察性实验。 单位：首都医科大学神经生物学系。 材料：实验于2000-03／2002-09在首都医科大学神经生物学系电生理学实验室完成。实验选用健康成年SD大鼠34只，体质量220～250g；健康成年家兔8只，体质量2．2-2．5kg。 方法：①10只大鼠经肌肉注射150-160万单位青霉素致痫，通过观察迷走神经刺激术前后大鼠大脑皮质电图、行为学的变化，研究迷走神经刺激术对致痫大鼠癫痫活动的影响。②另外8只大鼠向海马内注入青霉素0．24～0．48mg致痫，观察迷走神经刺激术对致痫大鼠痫性大脑皮质电图的影响。③16只大鼠皮下注射海人藻酸致痫。经迷走神经刺激术观察致痫大鼠海马神经元放电活动、大脑皮质电图及行为学变化。④8只家兔用微量注射器向皮层滴注士的宁致痫，观察迷走神经刺激术对急性皮层损伤致痫家兔的大脑皮质电图的影响。 主要观察指标：①迷走神经刺激术对青霉素致痫大鼠痫性发作的影响。 ②迷走神经刺激术对海人藻酸致痫的大鼠痫性发作的影响。③迷走神经刺激对士的宁致痫家兔痫性大脑皮质电图的影响。 结果：34只大鼠，8只家兔均进入结果分析。迷走神经刺激可以阻抑各组致痫动物的痫性发作，痫性皮质电图、海马神经元电活动及行为学表现均呈现显著的变化，总有效率达50％以上。如在癫痫发作前先行迷走神经刺激，有效率可达80％以上。肌肉注射青霉素致痫组，行为学及大脑皮质电图明显改善分别为40％和50％。海马内注射青霉素致痫组。50％的大鼠大脑皮质电图明显改BACKGROUND： Stellate ganglion block （SGB） has become a technique frequently used in the field of pain management for its wide indication spectrum. Its ameliorative effect on cephal-facial pain may be achieved by regulating the cerebrovascular diastolic and systolic functions and intensifying cerebral perfuaion. OBJECTIVE： To observe the influence of SGB on the blood velocity of anterior cerebral artery （ACA）, middle cerebral artery （MCA）, posterior cerebral artery （PCA） and vertebral artery with three-dimensional transcranial Doppler （TCD） in patients with caphal-facial diseases caused by ischemia or vascular spasm. DESIGN： A before-after control observation. SETTINGS： Department of Pain Management, Guizhou Provincial Orthopaedic Hospital; Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical College; Department of Anesthesiology, the Second Affiliated Hospital of Sun Yat-sen University. PARTICIPANTS： Twenty patients of 18-50 years old were selected from the Department of Pain Management of Guizhou Provincial Orthopaedic Hospital from March 2004 to December 2005, including 6 cases of migraine, 3 of cluster headache, 4 of muscle tension-type headache, 2 of nervous tinnitus and earache, and 5 of derangement of temporomandibular joint. METHODS： Unilateral SGB was performed by means of paratrachcal anterior technique, with the following compound prescription： lidocaine （20 g/L） 2.5 mL and dexamethasone 1 mg in normal saline with a total volume of 10 mL SGB was performed once a day for 7 consecutive days as one course. MAIN OUTCOME MEASRES： The changes of blood velocity of ACA, MCA, PCA and vertebral artery were observed with three-dimensional TCD before SGB and at 30 minutes after SGB. RESULTS： All the 20 patients finished the treatment and entered the analysis of results. After treatment, the blood velocities of ACA, MCA and PCA of the blocked side were increased remarkably as compared with those before treatment [（76.20±3.83）, �

关 键 词：癫痫 迷走神经 电刺激 大脑皮质 

分 类 号：R742.1[医药卫生—神经病学与精神病学]