不同时机开颅去骨瓣减压治疗恶性大脑中动脉区梗死的实验研究  

Curative effect comparison of craniectomy in rats with malignant middle cerebral artery infarction in different time: An experimental study

作　　者：赵湛[1] 余剑[1] 熊丽[1] 曾进胜[1] 

机构地区：[1]中山大学附属第一医院神经科,广州510080

出　　处：《中国神经精神疾病杂志》2006年第3期235-238,共4页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金(39940012;30271485);美国CMB基金(00-730);广东省自然科学基金(990065);卫生部临床学科重点项目(2004年);广东省自然科学基金攻关项目(B30303;2003D30301);教育部高校青年教师奖励计划(2002年)

摘　　要：目的比较高血压大鼠一侧大脑中动脉主干闭塞后不同时间点进行开颅去骨瓣减压术的疗效。方法将168只易卒中型肾血管性高血压大鼠(RHRSP)随机分为1、4、12、24h手术组,每组各32只,分别于MCA闭塞后1、4、12、24h开颅手术。另40只作为假手术对照组。使用线栓法复制MCA梗死模型。比较各组大鼠病死率、梗塞灶体积和神经功能评分,以评估不同时间点手术的疗效。结果1、4、12和24h手术组大鼠术后病死率分别为15.6%、12.5%、15.6%和28.1%,均低于假手术对照组(52.5%)(P均小于0.05)。1、4和12h手术组术后1、2周神经功能评分均低于同期对照组和24h手术组(P<0.05),4、8周各手术组神经功能评分均低于同期对照组(P<0.05)。1、4、12h手术组术后1、2周梗塞灶体积小于同期对照组和24h手术组(P<0.05),1、4、12h手术组4、8周的梗塞灶体积小于同期对照组,24小时手术组术后第1、2、8周梗塞灶体积小于对照组(P<0.05),1h手术组4周和12h组4、8周的梗塞灶体积小于24h手术组(P<0.05)。结论大鼠大脑中动脉主干闭塞后1～24h内开颅去骨瓣减压均可降低病死率。12h内手术者术后神经功能恢复较好。Objective To evaluate the effects for malignant middle cerebral artery infarction therapy by craniectomy in different time point. Methods 168 stroke -prone renovascular hypertensive rats （RHRSP）were divided ramdomly into 5 groups. Control group with 40 rats without any treatment after MCA occlusion. Group 1 hour,4 hours,12hours or 24 hours with 32 rats each were perform craniectomy at 1.4.12 or 24 hours after MCA occlusion, respectively. An endovascular technique was used to obtain left MCA occlusion in all rats. Mortality , infarct volume and neurological performance were used to evaluate the effects of craniectomy in different time point. Results Mortality in group 1 hour,4 hours,12 hours and 24 hours were 15.6% ,12. 5% ,15.6% and 28. 1% respectively , which were significant lower than control group（52. 5% ） （P 〈0. 05）. Neurological score in group 1 hour, 4 hours and 12 hours were significantly lower than these in control group and group 24 hours at week 1 and week 2 aftercraniectomy （P 〈 0. 05 ）. Neurological score in group 1 hours, 4 hours, 12 hours and 24 hours were lower than that in control group at week 4 and week 8 after craniectomy （ P 〈 0. 05 ）. Infarct volume in group 1 hour,4 hours and 12 hours were significantly smaller than this in control group at week 1,2,4 and 8 after crainectomy（P 〈0.05 ） ,infarct volum in group 24 hours at week 1,2 and 8 were significontly smaller than that in control group（P 〈0. 05 ）. Infarct volume in group 1 hour, 4 hours and 12 hours were smaller than this in group 24 hours in week 1 and 2 after craniectomy （ P 〈 0. 05 ）. Infarct volume in 1 hour or 12 hours was smaller than that in 24 hours group at week 4 or week 4 and 8 after craniectomy, respectively （ P 〈 0.05 ）. Conclusion Craniectomy performed at 1 - 24 hours after MCA occlusion could all reduce rats mortality. Rats with craniectomy at 1 - 12 hours after MCA occlusion performed lower neurological score and smaller infarct volume at week 1 and week 2.

关 键 词：大脑中动脉 脑梗死 开颅去骨瓣减压术 病死率 

分 类 号：R651.11[医药卫生—外科学]