兔蛛网膜下腔出血后血糖变化对脑内能量代谢影响的微透析研究  

Microdialysis Study on the Effect of Blood Glucose Changes on Cerebral Energy Metabolism after Subarachnoid Hemorrhage in Rabbits

作　　者：习斌[1] 梁爱军[1] 孙卫[1] 万登峰[1] 钟凤英[1] 刘健民[1] 张建中[1] 郭猷殚[1] 罗帷 XI Bin;LIANG Aijun;SUN Wei;WAN Dengfeng;ZHONG Fengying;LIU Jianmin;ZHANG Jianzhong;GUO Youdan;LUO Wei(Jiangxi Provincial People’s Hospital,Nanchang 330006,China)

机构地区：[1]江西省人民医院,江西南昌330006

出　　处：《中国医学创新》2020年第31期26-29,共4页Medical Innovation of China

基　　金：江西省卫生计生委科技计划项目(20165040)。

摘　　要：目的:探究微透析技术检测蛛网膜下腔出血后血糖及能量代谢物质动态变化的效果,胰岛素治疗对脑内血糖及代谢物质量的影响,为及时诊断蛛网膜下腔出血提供依据。方法:选取家兔32只,按随机数字表法分为模型组和正常组,每组各16只。模型组双次注射自身血液,正常组双次注射等量生理盐水。对模型组进行数字减影血管造影(DSA)测血管直径,经颅多普勒(TCD)测血流速度,两组分别进行微透析测脑内血糖、能量代谢物质含量,得出血管直径、血流速度、血糖、能量代谢物质与蛛网膜下腔出血相关性分析;测定结束给予模型组胰岛素注射,微透析检测血糖及能量代谢物质。结果:轻、中度血管痉挛与血流速度呈现正相关(P<0.05),与血管直径呈现负相关(P<0.05);重度痉挛与血管直径、血流速度相关性差(r=0.02,P>0.05);血管痉挛发生程度与血糖值、乳酸含量均呈有明显正相关性(P<0.05),与丙酮酸值有高度负相关性(P<0.05)。注血后第1、4、7天,模型组血糖、乳酸升高,丙酮酸降低,与建模前比较,差异均有统计学意义(P<0.05)。处理后,模型组与注射胰岛素前比,血糖、乳酸含量明显下降,丙酮酸含量升高,差异均有统计学意义(P<0.05),处理后,模型组与正常组的血糖、乳酸、丙酮酸比较,差异均无统计学意义(P>0.05)。结论:微透析技术检测脑内血糖、脑内能量代谢物质含量的变化与蛛网膜下腔出血的发生诊断有很好的相关性,可及时对不同程度的脑损伤诊断;胰岛素能改善脑损降低高血糖,减轻脑损伤发展,对治疗蛛网膜下腔出血有较好的效果,值得在临床上推广应用。Objective:To explore the effect of microdialysis on the dynamic changes of blood glucose and energy metabolites after subarachnoid hemorrhage,the effect of insulin therapy on the quality of blood glucose and metabolites in the brain,so as to provide basis for the timely diagnosis of subarachnoid hemorrhage.Method:A total of 32 rabbits were divided into the model group and the normal group according to the random number table method,16 rabbits in each group.The model group received double injections of their own blood,while the normal group received double injections of normal saline.Digital subtraction angiography (DSA) was used to measure blood vessel diameter in the model group,and transcranial Doppler (TCD) was used to measure blood flow velocity.Microdialysis was used to measure blood glucose and energy metabolites in the brain in the two groups,the correlation analysis between blood vessel diameter,blood flow velocity,blood glucose,energy metabolites and subarachnoid hemorrhage was obtained.At the end of measurement,insulin injection was given to the model group,blood glucose and energy metabolites were detected by microdialysis.Result:Mild and moderate vasospasm was positively correlated with blood flow velocity (P<0.05),negatively correlated with blood vessel diameter (P<0.05).The correlation between severe spasm and vascular diameter,blood flow velocity was poor (r=0.02,P>0.05).The incidence of vasospasm was positively correlated with blood glucose and lactic acid (P<0.05),negatively correlated with pyruvate (P<0.05).On the first,fourth and seventh days after blood injection,blood glucose,lactic acid increased and pyruvate decreased in the model group,with statistically significant differences compared with those before modeling (P<0.05).After treatment,in the model group the blood glucose,lactic acid were significantly decreased and pyruvate levels increased compared with those before insulin injection,with statistically significant differences (P<0.05).After treatment,in the model group the blood glucos

关 键 词：微透析 蛛网膜下腔出出血 能量代谢 胰岛素 

分 类 号：R743.35[医药卫生—神经病学与精神病学]