不同液体治疗方案对患者脑组织含水量、颅内压以及脑组织水通道蛋白-4和N-甲基-D-天冬氨酸受体-1表达的影响  

Effects of Different Liquid Therapies on Brain Water Content,Intracranial Pressure,and Expressions of Aquaporin-4 and N-methyl-D-aspartate Receptor-1 in Cerebral Tissue

作　　者：王霞[1] 刘超[2] 张雪宁[2] 闵苏[3] 刘东[4] 魏珂[3] 董军[3] 罗洁[3] 刘小滨[3] 

机构地区：[1]天津市人民医院急诊科,天津300121 [2]天津医科大学第二医院放射科,天津300211 [3]重庆医科大学附属第一医院麻醉科,重庆400016 [4]天津医科大学第二医院神经外科,天津300211

出　　处：《中国医学科学院学报》2012年第5期523-529,共7页Acta Academiae Medicinae Sinicae

基　　金：中华麻醉学会2009年度贝朗青年麻醉科学基金(30972831)~~

摘　　要：目的探讨使用不同胶体以及不同晶胶比对患者颅内压、脑组织含水量和脑组织水通道蛋白-4(AQP-4)、N-甲基-D-天冬氨酸受体-1(NMDAR-1)表达及术后格拉斯哥昏迷量表评分的影响。方法按随机单位组析因设计设置2个干预因素,即胶体因素(2水平:4%琥珀酰明胶、6%中分子羟乙基淀粉)和晶胶比因素(2水平:0∶1、1∶1)的所有组合,将32例进行癫痫灶区切除术的患者随机分为4组(n=8)。术中监测颅内压;术后检测切除脑组织中的脑水含量和AQP-4和NMDAR-1的表达;测定术后2 h患者的格拉斯哥昏迷量表评分。结果 6%中分子羟乙基淀粉较4%琥珀酰明胶以及晶胶比1∶1较晶胶比0∶1均可增加液体治疗期间的平均颅内压(F=55.714,P=0.000;F=142.432,P=0.000)、脑水含量(F=31.477,P=0.000;F=84.896,P=0.000)以及AQP-4(F=37.205,P=0.000;F=149.652,P=0.014)和NMDAR-1的表达(F=29.664,P=0.000;F=65.951,P=0.000),两者的影响均呈相加效果(颅内压:F=11.056,P=0.002;脑组织含水量:F=8.007,P=0.008;AQP-4的表达:F=9.845,P=0.004;NMDAR-1的表达:F=5.020,P=0.033);但术后2 h的格拉斯哥昏迷量表评分差异无统计学意义(P>0.05)。结论 4%琥珀酰明胶较6%中分子羟乙基淀粉、晶胶比1∶1较晶胶比0∶1对脑含水量及颅内压的控制更好,更适合神经外科围手术期使用;但不同胶体和晶胶比的液体治疗方案对术后神经精神评分无明显影响,均可安全使用。Objective To explore the effects of different liquid therapies on the intracranial pressure, brain water content, and expressions of aquaporin-4 and N-methyl-D-aspartate-1 in the brain tissue. Methods Two intervention factors including the colloids （two levels： 4% gelofusine; 6% hydroxyethyl starch and sodium chloride injection） and the crystal/gel ratios （two levels： 0：1 ; 1：1 ） were set based on the results of the analysis of variance of factorial design. Thirty-two patient who had undergone epilepsy surgery were equally and randomly divided into four groups： group A （4% gelofusine, crystal/gel ratio 0：1 ） ; group B （6% hydroxyethyl starch and sodium chloride injection, crystal/gel ratio 0：1 ） ; group C （4% gelofusine, crystal/gel ratio 1：1 ） ; and group D （6% hydroxyethyl starch and sodium chloride injection, crystal/gel ratio 1：1 ）. The intracranial pressure during operation was recorded. After the operation, the intracranial pressure and brain water content were measured and the expressions of aquaporin-4 and N-methyl-D-aspartate-1 in the brain tissue were deter- mined with Western blot. Glasgow coma scores were obtained 2 hours after operation. Results The intracrani- al pressure （ F = 55.714, P = 0. 000 ; F = 142. 432, P = 0. 000） and the brain water content （ F = 31. 477, P = 0. 000 ; F = 84. 896, P = 0. 000 ） significantly increased after the application of the 6% hydroxyethyl starch and sodium chloride injection and crystal/gel ratio 1 ： 1, and the expressions of aquaporin-4 （ F = 37.205, P = 0. 000 ; F = 149. 652, P = 0. 014） and N-methyl-D-aspartate-1 （ F = 29.664, P = 0. 000 ; F = 65. 951, P = 0. 000） in the brain tissue significantly increased. There were additive effects between two of them （ the intracranial pressure ： F = 11. 056, P = 0. 002 ; the brain water content ： F = 8. 007, P = 0. 008 ; the expression of aquaporin-4 ： F = 9. 845, P = 0. 004 ; and the expression of N-methyl-D-aspartate-1 ： F = 5. 020, P -0. 033 ）. Howe

关 键 词：液体治疗 脑含水量 颅内压 水通道蛋白-4 N-甲基-D-天冬氨酸受体-1 

分 类 号：R451[医药卫生—治疗学] R452[医药卫生—临床医学]