不同时间浅低温对蛛网膜下腔出血犬脑血管痉挛的影响  

Effect of mild hypothermia of different duration on cerebral vasospasm following subarachnoid hemorrhage in dogs

作　　者：王志萍[1] 陈红生[2] 王凤祥[2] 

机构地区：[1]徐州医学院附属医院麻醉科,221002 [2]江苏省麻醉医学研究所

出　　处：《中华麻醉学杂志》2010年第2期209-212,共4页Chinese Journal of Anesthesiology

基　　金：江苏省卫生厅资助项目（H200723）;江苏省医学重点人才资助项目（RC2007093）;江苏省高校自然科学重大基础研究项目（08KJA320001）

摘　　要：目的探讨不同时间浅低温对蛛网膜下腔出血犬脑血管痉挛的影响。方法成年健康犬30只，雌雄不拘，体重14～20kg，采用枕骨大孔二次注血法制备犬蛛网膜下腔出血模型。随机分为5组（n=6），人工脑脊液组（ACSF组）：枕骨大孔处注入ACSF 0．5ml／kg；蛛网膜下腔出血组（SAH组）：制备蛛网膜下腔出血模型，维持直肠温度38～39℃；不同时间浅低温组（H1-3组）：在第2次注血后分别立即实施8、16和32h浅低温（33．5℃），随后复温至38—39℃。于第1次注血或注入ACSF前和第2次注血或注入ACSF5、12和19d时行整体功能分级（OPC），并采用ELISA法和硝酸还原酶法分别测定血浆和脑脊液内皮素-1（ET-1）和一氧化氮（NO）代谢产物NO2^-／NO3^-的浓度，采用CT血管造影动态测量脑基底动脉直径。结果与ACSF组比较，SAH组和H1、2组OPC分级升高，血浆和脑脊液ET-1浓度升高，NO2^-／NO3^-浓度降低，基底动脉直径减小（P〈0．05），H3组上述指标差异无统计学意义（P〉0．05）；与SAH组比较，H2、3组OPC分级降低，血浆和脑脊液ET-1浓度降低，NO2^-／NO3^-浓度升高，基底动脉直径增大（P〈0．05），H1组各时点上述指标差异无统计学意义（P〉0．05）；与H2组比较，H3组血浆和脑脊液ET-1浓度降低，NO2^-／NO3^-浓度升高，基底动脉直径增大（P〈0．05）。结论浅低温16～32h可缓解蛛网膜下腔出血犬脑血管痉挛，且随浅低温时间延长该作用增强，其机制可能与降低全身和脑组织ET-1水平，升高NO水平，调节脑血管收缩．舒张平衡有关。Objective To investigate the effect of mild hypothermia of different duration on cerebral vasospasm following subarachnoid hemorrhage （SAH） in dogs. Methods Adult healthy mongrel dogs of both sexes weighing 14-20 kg were used in this study. SAH was induced by 2 injections of non-anticoagulated autologous blood 0.5 ml/kg into foramen magnum at an interval of 48 h. Thirty dogs were randomly divided into 5 groups （ n = 6 each）： group Ⅰ control （group C）; group Ⅱ SAH; group Ⅲ, Ⅳ, Ⅴ SAH ＋ 8, 16, 32 h mild hypothermia （gnoup H8 h, H16 h, H32 h）. In control group artificial cerebro-spinal fluid （ACSF） 0.5 ml/kg was injected into foramen magnum instead of autologous blood. In group Ⅲ, Ⅳ, Ⅴ the dogs were cooled after the second intra- foramen magnum injection via an endovascular cooling device to 33.5 ℃ （rectal temperature ） which was maintained for 8, 16 and 32 h respectively. The overall neurological performance was categorized （OPC） and scored （0 = normal. 4 = coma）, plasma and CSF concentrations of ET-1 and NO2^-/NO3^- were measured and the change in the diameter of cerebral basilar artery was determined by CT angiography before first intra-foramen magnum injection and at 5, 12 and 19 d after the second injection. Results The OPC score and plasma and CSF concentrations of ET-1 were significantly increased while plasma and CSF NO2^-/NO3^- concentrations and diameter of cerebral basilar artery were significantly decreased after the second injection as compared with the baseline before 1st injection in group SAH, H8 h and H16 h. The OPC scores and plasma and CSF ET-1 concentrations were significantly lower while plasma and CSF NO2^-/NO3^- concentrations were significantly higher and the diameter of cerebral basilar artery was significantly larger in group H16 h and H32 h than in group SAH. Conclusion Mild hypothermia （33.5 ℃ ） maintained for 16-32 h can attenuate the cerebral vasospasm by decreasing plasma and CSF ET-1 concentration and increasing plasma and CSF

关 键 词：低温 人工 蛛网膜下腔出血 血管痉挛 颅内 

分 类 号：R743.35[医药卫生—神经病学与精神病学]