脑死亡过程中脑组织氧代谢变化的动物实验研究  

Experimental animal study of cerebral oxygen metabolism changes during the process of brain death

作　　者：齐华英[1] 万晨光[1] 冯学泉[1] 李牧[1] 陈立[2] 王勇强[3] 史源[4] 刘蕾[4] 沈中阳[4] 

机构地区：[1]天津市第一中心医院神经外科,300192 [2]天津市第一中心医院检验科,300192 [3]天津市第一中心医院重症医学科,300192 [4]天津市第一中心医院移植外科,300192

出　　处：《中华危重病急救医学》2017年第7期640-643,共4页Chinese Critical Care Medicine

基　　金：国家高技术研究发展计划（863计划）项目（2012AA021001）;国家临床重点专科建设项目（2011-873-2013-544）

摘　　要：目的 建立稳定的猪脑死亡动物模型,观察脑组织氧代谢在脑死亡过程中的变化规律,评价脑组织氧代谢指标在脑死亡判定中的意义和价值.方法 选择12只长白猪作为研究对象,应用改良硬膜外水囊加压法建立脑死亡动物模型,实时监测平均动脉压（MAP）及颅内压（ICP）.按脑死亡模型构建过程中脑灌注压（CPP）下降程度分为CPP正常组及CPP下降0%~30%、30%~70%、70%~100%组.分别经颈外动脉和颈内静脉球部置管进行血气分析,观察颈外动脉-颈内静脉球部血氧含量差（AJDO2）、颈内静脉球部-颈外动脉血二氧化碳分压差（DPCO2）及DPCO2/AJDO2比值等脑组织代谢指标的变化.结果 12只实验猪均成功建立了脑死亡模型,在MAP和ICP监测情况下,可稳定重复构建不同阶段CPP的模型.随CPP下降,AJDO2、DPCO2呈先升高后降低趋势,DPCO2/AJDO2比值则逐渐升高;CPP下降0%~30%组AJDO2明显高于CPP正常组〔（5.86±1.21）%比（3.92±0.64）%〕,CPP下降0%~30%组和CPP下降30%~70%组DPCO2均明显高于CPP正常组〔mmHg（1 mmHg=0.133 kPa）：10.33±1.83、11.48±2.32比6.11±1.43〕,CPP下降30%~70%组和CPP下降70%~100%组DPCO2/AJDO2比值均明显高于CPP正常组和CPP下降0%~30%组（2.81±0.53、4.12±1.07比1.57±0.64、1.62±0.81）,差异均有统计学意义（均P〈0.05）.结论 脑死亡过程中,随CPP降低,脑氧代谢指标呈规律性变化;DPCO2联合DPCO2/AJDO2比值是反映颅内低灌注的可靠血气分析指标,对脑死亡的判定有一定的参考价值.Objective To reproduce a stable animal model of brain death in pigs, observe the change regularity of cerebral oxygen metabolism during the process of brain death, and to evaluate the significance and value of cerebral oxygen metabolism parameters for the diagnosis of brain death. Methods Twelve landrace pigs were used to create the brain death models using modified method of increasing epidural intracranial pressure （ICP）. The mean arterial pressure （MAP） and ICP were monitored continuously during the process. The pigs were divided into four groups according to cerebral perfusion pressure （CPP） decreasing degree during brain death, namely CPP normal group and CPP decreasing 0%-30%, 30%-70%, and 70%-100% groups. Blood gas analysis of the external carotid artery and internal jugular vein were monitored discontinuously. The changes in cerebral oxygen metabolism parameters, including external carotid artery-internal jugular vein bulb oxygen content difference （AJDO2）, internal jugular bulb-external carotid artery carbon dioxide partial pressure difference （DPCO2） and DPCO2/AJDO2 ratio, were observed. Results Brain death model were successfully reproduced in 12 experimental pigs. With MAP and ICP monitoring, the models at different stages of CPP could be repeatedly induced. The levels of AJDO2 and DPCO2 were increased gradually and then decreased, while the ratio of DPCO2/AJDO2 was constantly increased with the decrease of CPP. The level of AJDO2 in CPP decreasing 0%-30%group was significantly higher than that in CPP normal group [（5.86±1.21）% vs. （3.92±0.64）%], the levels of DPCO2 in CPP decreasing 0%-30% and CPP decreasing 30%-70% groups were significantly higher than those in CPP normal group [mmHg （1 mmHg = 0.133 kPa）： 10.33±1.83, 11.48±2.32 vs. 6.11±1.43], and the ratios of DPCO2/AJDO2 in CPP decreasing 30%-70% and CPP decreasing 70%-100% groups were significantly higher than those in CPP normal group and CPP decreasing 0%-30% group （2.81±0.53, 4.12±1.07 vs. 1.57±0.64,

关 键 词：脑死亡 脑氧代谢 血气分析 

分 类 号：R-332[医药卫生] R741