不同温度停循环的脑损伤评估及机制研究  

Evaluation of Cerebral Injury after Different Hypothermic Circulatory Arrests and the Mechanism Research

作　　者：孙燕华[1] 郭莎莎[1] 韩晓菲[1] 杜英杰[1] 刘刚[1] 刘晋萍[1] 吉冰洋[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心血管疾病国家重点实验室体外循环科,北京市100037

出　　处：《中国分子心脏病学杂志》2014年第2期853-856,共4页Molecular Cardiology of China

基　　金：国家自然科学基金面上项目(81270384)

摘　　要：目的深低温停循环(deep hypothermic circulatory arrest,DHCA)应用于主动脉弓和复杂先心病手术,停循环为手术提供无血视野,降温到一定程度以保护脏器。DHCA术后神经系统并发症较高,而不同程度的低温停循环对脑造成的影响与机制目前还未完全明确。方法 20只SD大鼠随机分为4组:深低温停循环组(15-20℃)、中低温停循环组(20-25℃)、浅低温停循环组(25-30℃)和假手术组,术后收集血样、脑组织,并分离海马组织。HE染色后评估神经元损伤情况。免疫组化观察各组HIF-1α的表达与分布。Elisa法测定血浆S100β浓度。Western blot检测各组海马组织凋亡相关蛋白Casepase3、Bax和Bcl-2表达量。结果 HE染色观察3组低温停循环组海马CA1区均有损伤表现,但组间无明显差异。HIF-1α阳性表达率、Casepase3、Bax和Bcl-2表达量,以及血浆S100β组间均无统计学差异。结论不同程度的低温后停循环带来大鼠脑组织损伤,但严重程度并不和温度呈线性关系,这表明低温对脑组织缺血再灌注损伤的影响有着较为复杂的机制。Objective Deep hypothermic circulatory arrest （DHCA） is widely used in aortic and complex congenital heart operations, in order to provide bloodless surgery field by arresting circulation, and to protect organs by reducing body temperature. However, the mechanism of cerebral injury after DHCA is still far away from fully understanding. Methods 20 SD rats were randomly divided to 4 groups： deep hypotbermic circulatory arrest（15-20℃）moderate hypothermic circulatory arrest （20-25℃）, mild hypothermic circulatory arrest（25-30℃） and sham group. Plasma, brain of rats were harvested after surgery, and the hippocampus was isolated. Injury of neurons was evaluated after HE staining. The expression pattern of HIF-lctwas observed by immunohistochemical staining. Elisa testing was used for plasma concentration of S10013. Western blot was used to quantify apoptosis-related proteins： Casepase3, Bax and Bcl-2. Results Neuroninjury appeared in 3 hypothermic circulatory arrest groups, but there was no apparent difference. There was no statistically significant difference of HIF-1α, S10013,Casepase3,Bax and Bcl-2 among groups. Conclusion Different hypothermic circulatory arrests contributed to cerebral injury, but there was no linear correlation between the injury severity and temperature. This indicated that the mechanism of cerebral injury after DHCA was complicated.

关 键 词：深低温停循环 脑损伤 不同温度 HIF-1A 凋亡 

分 类 号：R654.1[医药卫生—外科学]