兔蛛网膜下腔出血后脑血管痉挛与脑细胞外液相关性实验研究  

Experimental research of the correlation between cerebral vasospasm and extracellular fluid after subarachnoid hemorrhage in rabbit

作　　者：万登峰[1] 贺建雄 梁爱军[1] 谭丽[3] 曹文峰[1] 高子云[1] 张建中[1] 古今海[1] 周晓清[1] 向晖[1] 

机构地区：[1]江西省人民医院神经外科,南昌330006 [2]宜春市人民医院神经外科,336000 [3]江西省人民医院B超室,南昌330006

出　　处：《中国微侵袭神经外科杂志》2010年第9期420-423,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：江西省科技厅社会发展支撑项目

摘　　要：目的探讨蛛网膜下腔出血(SAH)后脑血管痉挛的脑代谢变化规律及其与脑血管痉挛程度的相关性。方法 16只成年新西兰白兔随机分为:枕大池2次注生理盐水组(NS组)8只,枕大池2次注血组(SAH组)8只。两组均采用微透析仪于注血(或生理盐水)前、后第1,3,5,7天检测脑细胞外液的葡萄糖、乳酸、丙酮酸、谷氨酸及天冬氨酸的浓度,并计算乳酸与丙酮酸(L/P)比值。经颅多普(TCD)测定两组兔基底动脉血流速度;DSA测定两组兔基底动脉直径。结果与注血前相比,SAH组注血后各指标均有不同程度变化。基底动脉直径显著缩小及血流速度明显增快均于第3天开始(P<0.05),并于第5天达高峰;且轻度和中度脑血管痉挛血流速度与管径呈负相关(γ轻=0.673,P<0.01;γ中=0.613,P<0.01)。乳酸和L/P比值均于第1天明显升高(P<0.05),第5天达高峰;且与基底动脉直径变化呈负相关(γ乳酸=0.624,P<0.01;γL/P=0.713,P<0.01)。谷氨酸第1天显著升高(P<0.05),后急剧下降。结论 TCD可通过检测血流速度变化判断兔脑血管痉挛情况,但痉挛程度的判断存在局限性。脑细胞外液乳酸和L/P比值变化可预测兔脑血管痉挛的发生并判断其痉挛程度。Objective To explore the cerebral metabolism change of cerebral vasospasm and the correlation between the change and vasospasm severity after subarachnoid hemorrhage（SAH） in rabbit.Methods Sixteen adult New Zealand rabbits were randomly and equally divided into twice normal saline injection group（NS group） and twice blood injection into cisterna magna group（SAH group）.The concentrations of glucose,lactic acid（Lac）,pyruvate,glutamate and aspartic acid were detected by microdialyzer before and days 1,3,5 and 7 after the injection of blood or normal saline,and then the ratio of lactate to pyruvate（L/P） calculated.The blood flow velocity of the basilar artery in rabbits of each group was monitored by transcranial Doppler（TCD） and the artery diameter was determined by DSA.Results Compared with pre-injection of blood,all indicators changed to different degrees after injection in SAH group.The diameter of the basilar artery significantly reduced,while blood velocity increased on the 3rd day,and both of them reached peak level on the 5th day.There was a negative correlation between the blood flow velocity and diameter in mild and moderate cerebral vasospasm（γmild =0.673,P0.01;γmoderate=0.613,P0.01）.Lactic acid and L/P ratio significantly increased on the 1st day（P0.05）,and both of them reached the peak level on the 5th day,which had a negative correlation with the diameter of basilar artery（γLac = 0.624,P0.01;γL/P=0.713,P0.01）.Glutamate level rose significantly on the 1st day（P0.05）,but then dropped sharply.Conclusions TCD can be used to estimate the situation of cerebral vasospasm by detecting blood flow velocity in rabbits,but the estimation of vasospasm degree is not consistent with the truth.Lactic acid and L/P ratio in brain extracellular fluid of rabbits can be used to forecast the occurrence of cerebral vasospasm and estimate the vasospasm severity.

关 键 词：蛛网膜下腔出血 血管痉挛 颅内 能量代谢 微透析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]