实验性犬脑出血治疗及康复的病理生理基础  

Discussion on pathophysiologic foundation of cerebral hemorrhage rehabilitation through therapeutic of experiment in dogs

作　　者：李恭[1,2] 冯殿福[1,2] 张晓奇 

机构地区：[1]吉林医学院脑血管病研究室,132001 [2]吉林医学院附属医院神经科,132001

出　　处：《中国康复医学杂志》1992年第2期50-54,共5页Chinese Journal of Rehabilitation Medicine

摘　　要：通过用20只犬实验性脑出血模型(治疗组和对照组,各10只)的急性期抢救和出血后恢复期的治疗情况,试图说明脑出血后康复的病理生理基础,从而进一步提高抢救及康复治疗的水平。结果表明,在急性期控制高颅压,1.0g/kg甘露醇+激素或速尿静注,5～10min后压力开始下降,30min后达最高点,原有压力可下降30％～50％,其有效时间可持续150±14.53min。在降颅压治疗中,应与甘油、高渗糖交替使用,并可加激素或速尿。一般间隔时间不应超过4h,否则颅压反跳可发生脑疝。用这种办法抢救活了15只(治疗组8只,对照组7只)。在康复期用中药平血灵治疗14日,(不限制动物活动)对照组不用该药。结果对照组恢复差,71.4％痴呆,EEG恢复慢,α波指数只增加16.4％,δ波遗留16.94％,异常EEG占88.9％。而治疗组无1例痴呆,EEG α波36.51％,δ波减少到6.79％,异常EEG仅占37.5％。治疗组:血小板聚集率明显低于对照组(P<0.05),血小板解聚率明显高于对照组(P<0.01)。注血后7日经过CT复查,治疗组3例高密度影消失,对照组3例高密度影未完全消失。大体解剖肉眼所见对照组脑水肿达两个加号以上者6只,85.7％。治疗组脑出血残留病灶范围明显小于对照组,P<0.01,光镜及电镜检查结果,治疗组处于康复期,对照组仍处于急性期和吸收期。结果表明:急性期抢救和康复期治疗互相结合,在了解病理生理的基础上,进行针对性治疗,则康复效果较好。Observation of intracranial pressure, EEG, ECG, CT scan, platelet aggregation and structure after anatomical examination under light and electron microscope have been done on 20 experimental cerebral hemorrhage dogs. Treatment and control groups were divided. The results showed that the best prescription of controlling intracranial pressure during acute stage of hemorrhage was mannity (1.0～1.5g/kg) with hormone and furosemide which could reduce 30%～50% of intracranial pressure and maintain its effect about 2.5～3h without any bouncing phenomenon. In the treatment group, absorption of hematoma was better than control group and could be revealed on CT, EEG, and microscope changes. The function of platelet aggregation was inhibited;the brain tissue reaction was in absorption period. A comparison between the two groups showed significant difference. These suggested that the combination of clinical management with early rehabilitation must be done to help the patient recover better.

关 键 词：实验 脑出血 康复 病理生理 

分 类 号：R743.340.2[医药卫生—神经病学与精神病学]