外伤性脑血管痉挛与脑脊液内皮素、一氧化氮浓度动态变化的临床研究  

Endothelin and nitric oxide concentration in patients with posttraumatic cerebral vasospasm

作　　者：王朝晖 宋钢 夏国道 李宁[2] 

机构地区：[1]无锡市仁德医院神经外科,江苏省214028 [2]上海第二医科大学附属瑞金医院神经外科

出　　处：《中华实用诊断与治疗杂志》2009年第3期229-231,共3页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的:研究重型颅脑外伤后脑脊液中内皮素、一氧化氮浓度动态变化与脑血管痉挛的关系。方法:重型脑外伤患者30例,入院时GCS<8分。入院后24 h及3,5,7 d动态检测双侧大脑中动脉与颈内动脉颅外段脑血流速度以及脑脊液内皮素与一氧化氮浓度。结果:13例(43%)发生脑血管痉挛。外伤后血管痉挛组与非痉挛组患者脑脊液中内皮素浓度均高于正常组,一氧化氮浓度均低于正常组。血管痉挛组患者内皮素及一氧化氮浓度变化过程同经颅多普勒超声表现相符,与非痉挛组比较差异有统计学意义(P<0.05);中、重度血管痉挛组与轻度血管痉挛组之间比较差异有统计学意义(P<0.05)。结论:颅脑外伤后脑血管痉挛发生率高;伤后脑血管痉挛发生的机制可能与脑脊液内皮素升高,一氧化氮抑制,导致血管收缩舒张平衡破坏有关。Objective To study the potential role of endothelin and nitric oxide in the pathogenesis of posttraumatic cerebral vasospasm. Methods Thirty patients with craniocerebral trauma and Glasgow Coma Scale Scores less than 8, were evaluated with transcranial Doppler sonography. Blood flow velocities were determined in bilateral middle cerebral artery and extracranial portion of internal carotid artery, and the cerebrospinal fluid concentrations of endothelin and nitric oxide were measured in 24 hours, 3 days, 5 days and 7 days. Results Vasospasm was found in 13 patients. In patients with severe craniocerebral trauma, the levels of endothelin in cerebrospinal fluid increased and the levels of nitric oxide were lower compared with those of normal controls. The levels of endothelin and nitric oxide were significantly different between patients with and without cerebral vasospasm, and between the patients with moderate and severe vasospasm and mild vasospasm（P〈0.05）. Conclusion Cerebral vasospasm is a common complication of craniocerebral trauma. The increase of endothelin and decrease of nitric oxide in cerebrospinal fluid may destroy the balance of vasoconstriction and vasodilation, and induce cerebral vasospasm.

关 键 词：颅脑外伤 脑血管痉挛 内皮素 一氧化氯 

分 类 号：R743.3[医药卫生—神经病学与精神病学]