MRS联合DWI观察实验性兔颅脑爆震伤后高压氧的治疗作用  

Hyperbaric oxygen therapy in rabbits after explosive brain injury： a MRS and DWI study

作　　者：杨艳艳[1] 刘家传[1] 张永明[1] 孙文江[1] 汤宏[1] 黄振山[1] 李兵仓[2] 张良潮[2] 

机构地区：[1]解放军第一○五医院神经外科,合肥230031 [2]第三军医大学大坪医院野战外科研究所,重庆400042

出　　处：《中华神经医学杂志》2011年第1期33-36,共4页Chinese Journal of Neuromedicine

基　　金：南京军区联勤部卫生部十一五重点基金项目（06Z19）

摘　　要：目的 利用磁共振波谱技术及磁共振弥散加权成像探讨高压氧治疗颅脑爆震伤不同时间段脑局部代谢及水分子运动的变化.方法 90只新西兰大白兔按随机数字表法分成对照组、创伤组和高压氧治疗组,后2组采用600 mg TNT当量纸雷管在兔脑上方6.5 cm垂直距离爆炸制作颅脑爆震伤模型,高压氧治疗组待生命体征稳定后即给予不同疗程的高压氧治疗.于模型制作后1 d、3 d、7 d、14d、21 d等时间点观察兔存活情况,磁共振波谱观察乙酰天门冬氨酸（NAA）/肌酸（Cr）、NAA/胆碱（Cho）＋Cr随时间发展的演变过程,磁共振弥散加权成像观察表观弥散系数（ADC）值随时间发展的演变过程.结果 创伤组NAA/Cr均值在损伤后明显下降,7 d后有所回升,高压氧治疗组NAA/Cr均值较创伤组高,比较差异有统计学意义（P＜0.05）.创伤组NAA/Cho＋Cr均值在损伤后即明显降低,高压氧治疗组NAA/Cho＋Cr均值较创伤组高,比较差异有统计学意义（P＜0.05）.创伤组兴趣区ADC值在1 d时明显下降,3 d后逐渐上升,高压氧治疗组ADC值均较创伤组高,比较差异有统计学意义（P＜0.05）.结论 高压氧可通过改善局部神经元代谢、抑制脑水肿、增强局部胶质增生修复等改善颅脑爆震伤的预后,伤后早期干预可能更有利.Objective To evaluate the role of magnetic resonance spectroscopy （MRS） and diffusion-weighted MRI （DWI） in detecting regional cerebral metabolic changes and changes of water molecular motion in rabbits after explosive brain injury at different time points of injury after being treated with hyperbaric oxygen therapy. Methods Ninety New Zealand white rabbits were divided into control group, trauma group and hyperbaric oxygen treatment group. The injured models in the later 2 groups were established using 600 mg TNT equivalent of paper detonators in the rabbit brain at the top of 6.5 cm vertical distance. Rabbits in the trauma group and hyperbaric oxygen treatment group were sub-divided into 1, 3, 7, 14 and 21 d treatment groups, respectively. The survival of these rabbits was observed at these time points. Hyperbaric oxygen treatments lasting for 1, 3, 7, 14 and 21 d were given to each hyperbaric oxygen treatment sub-groups, respectively. Performance under MRS was detected and dynamic changes of N-acetylaspartate （NAA）/creatine （Cr） ratio and NAA/choline（Cho）＋Cr value were observed with MRS. DWI was employed to detect the dynamic changes of apparent diffusion coefficient （ADC） values. Results The NAA/Cr ratio in the trauma group markedly decreased right after the injury and slightly rose 7 d after the injury. Compared with that in the trauma group, the NAA/Cr ratio in the hyperbaric oxygen treatment group was significantly increased （P〈0.05）. The NAA/Cho＋Cr value in the trauma group was markedly decreased right after the injury, while that in the hyperbaric oxygen treatment group was obviously increased as compared with that in the trauma group （P〈0.05）. ADC values in the region of interest of the trauma group was decreased after 1 d of treatment and gradually increased after 3 d of treatment; the ADC values in the hyperbaric oxygen treatment group was obviously higher than those in the trauma group （P〈0.05）. Conclusion Hyperbaric oxygen might improve the prognosis by

关 键 词：颅脑损伤 冲击伤 磁共振波谱 磁共振弥散加权成像 高压氧 

分 类 号：R651.15[医药卫生—外科学]