兔颈内动脉选择性脑低温对急性局灶性脑缺血后脑水肿及脑灌注压的影响  

Impact of selective carotid artery hypothermia on cerebral edema and perfusion pressure after acute focal cerebral ischemia in rabbits

作　　者：王晓锋[1] 罗一峰[1] 秦峥[2] 潘速跃[3] 陆兵勋[3] 

机构地区：[1]南方医科大学第三附属医院神经内科,广州510630 [2]南方医科大学第三附属医院科教科 [3]南方医科大学南方医院神经内科,广州510515

出　　处：《中华神经医学杂志》2013年第10期1005-1010,共6页Chinese Journal of Neuromedicine

基　　金：南方医科大学第三附属医院院长基金（B2010081

摘　　要：目的探讨兔颈内动脉选择性脑低温对急性局灶性脑缺血后脑水肿及脑灌注压的影响。方法32只雄性新西兰白兔按随机数字表法分为大脑中动脉阻塞组（MCAO）组、MCAO＋冷生理盐水灌注30min组（I1组）、MCAO＋冷生理盐水灌注60min组（I3组）、MCAO＋38oC生理盐水灌注组（I3组），每组各8只。MCA0术前15min及术后3h（生理盐水灌注前）、4h（生理盐水灌注后1h）监测各组动物肛温、心率、平均动脉压、血气[pH、氧分压（PO2）、二氧化碳分压（PC02]）、血糖等生理指标。MCAO术前及术后1h、3h、6h、12h、24h、48h连续测量有创颅内压．同时记录平均动脉压，以计算相应时间点脑灌注压。MCAO术后48h各组动物取脑组织经TTC染色后计算水肿指数。结果（1）各组动物各时间点间各项生理指标比较差异均无统计学意义（P〉0．05）。（2）各组动物各时间点之间脑灌注压比较差异均有统计学意义（P〈0．05），脑灌注压在MCAO术后3h内持续降低，之后维持在一个较稳定的水平。各时间点各组动物之间脑灌注压比较差异无统计学意义（P〉0．05）。（3）各组动物之间脑水肿指数比较差异有统计学意义（P〈0．05）．其中I2组脑水肿指数明显低于M组和I3组，差异有统计学意义（P〈0．05）。结论颈内动脉内冷生理盐水灌注60min选择性降低脑温可显著减轻急性局灶性脑缺血后脑水肿，增加灌注压，在急性期起到脑保护作用。Objective To explore the impact of selective carotid artery hypothermia on cerebral edema and perfusion pressure after acute focal cerebral ischemia in rabbits. Methods Thirty-two male New Zealand white rabbits were randomly divided into middle cerebral artery occlusion （MCAO） group （n=8）, MCAO＋cold saline infusion groups （30 and 60 min perfusion subgroups, 11 and I2 groups, n=8）, MCAO＋38 ~C saline infusion group （13 group, n=8）. Rectal temperature, heart rate, mean arterial pressure, blood gas （pH, PO2, PCO2） and glucose were detected 15 min before MCAO, and 3 and 4 h after surgery. Intracranial pressure and mean arterial pressure were measured to calculate the perfusion pressure before MCAO, and 1, 3, 6, 12, 24 and 48 h after surgery. The cerebral edema extent was measured with TTC staining 48 h after MCAO. Results Baseline data between groups balanced （all P〉0.05）. Cerebral perfusion pressure at different time points were significantly different （P〈0.05）; cerebral perfusion pressure within 3 h after MCAO continued to decrease, then maintained at a relatively stable level. There was significant difference of edema index between the groups （P〈0.05）; edema index in 12 group was significantly lower than that in the M and 13 groups （P〈0.05）. Conclusion Selective carotid artery hypothermia for 60 min significantly reduces cerebral edema and increases cerebral perfusion pressure,which is conducive to the neuronal protection after MCAO.

关 键 词：急性局灶性脑缺血 选择性脑低温 脑水肿 脑灌注压 

分 类 号：R743.3[医药卫生—神经病学与精神病学]