不同时间浅低温对蛛网膜下腔出血犬脑血管痉挛的影响被引量：1

Effect of mild hypothermia of different duration on cerebral vasospasm following subarachnoid hemorrhage in dogs

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摘要目的探讨不同时间浅低温对蛛网膜下腔出血犬脑血管痉挛的影响。方法成年健康犬30只，雌雄不拘，体重14～20kg，采用枕骨大孔二次注血法制备犬蛛网膜下腔出血模型。随机分为5组（n=6），人工脑脊液组（ACSF组）：枕骨大孔处注入ACSF 0．5ml／kg；蛛网膜下腔出血组（SAH组）：制备蛛网膜下腔出血模型，维持直肠温度38～39℃；不同时间浅低温组（H1-3组）：在第2次注血后分别立即实施8、16和32h浅低温（33．5℃），随后复温至38—39℃。于第1次注血或注入ACSF前和第2次注血或注入ACSF5、12和19d时行整体功能分级（OPC），并采用ELISA法和硝酸还原酶法分别测定血浆和脑脊液内皮素-1（ET-1）和一氧化氮（NO）代谢产物NO2^-／NO3^-的浓度，采用CT血管造影动态测量脑基底动脉直径。结果与ACSF组比较，SAH组和H1、2组OPC分级升高，血浆和脑脊液ET-1浓度升高，NO2^-／NO3^-浓度降低，基底动脉直径减小（P〈0．05），H3组上述指标差异无统计学意义（P〉0．05）；与SAH组比较，H2、3组OPC分级降低，血浆和脑脊液ET-1浓度降低，NO2^-／NO3^-浓度升高，基底动脉直径增大（P〈0．05），H1组各时点上述指标差异无统计学意义（P〉0．05）；与H2组比较，H3组血浆和脑脊液ET-1浓度降低，NO2^-／NO3^-浓度升高，基底动脉直径增大（P〈0．05）。结论浅低温16～32h可缓解蛛网膜下腔出血犬脑血管痉挛，且随浅低温时间延长该作用增强，其机制可能与降低全身和脑组织ET-1水平，升高NO水平，调节脑血管收缩．舒张平衡有关。 Objective To investigate the effect of mild hypothermia of different duration on cerebral vasospasm following subarachnoid hemorrhage （SAH） in dogs. Methods Adult healthy mongrel dogs of both sexes weighing 14-20 kg were used in this study. SAH was induced by 2 injections of non-anticoagulated autologous blood 0.5 ml/kg into foramen magnum at an interval of 48 h. Thirty dogs were randomly divided into 5 groups （ n = 6 each）： group Ⅰ control （group C）; group Ⅱ SAH; group Ⅲ, Ⅳ, Ⅴ SAH ＋ 8, 16, 32 h mild hypothermia （gnoup H8 h, H16 h, H32 h）. In control group artificial cerebro-spinal fluid （ACSF） 0.5 ml/kg was injected into foramen magnum instead of autologous blood. In group Ⅲ, Ⅳ, Ⅴ the dogs were cooled after the second intra- foramen magnum injection via an endovascular cooling device to 33.5 ℃ （rectal temperature ） which was maintained for 8, 16 and 32 h respectively. The overall neurological performance was categorized （OPC） and scored （0 = normal. 4 = coma）, plasma and CSF concentrations of ET-1 and NO2^-/NO3^- were measured and the change in the diameter of cerebral basilar artery was determined by CT angiography before first intra-foramen magnum injection and at 5, 12 and 19 d after the second injection. Results The OPC score and plasma and CSF concentrations of ET-1 were significantly increased while plasma and CSF NO2^-/NO3^- concentrations and diameter of cerebral basilar artery were significantly decreased after the second injection as compared with the baseline before 1st injection in group SAH, H8 h and H16 h. The OPC scores and plasma and CSF ET-1 concentrations were significantly lower while plasma and CSF NO2^-/NO3^- concentrations were significantly higher and the diameter of cerebral basilar artery was significantly larger in group H16 h and H32 h than in group SAH. Conclusion Mild hypothermia （33.5 ℃ ） maintained for 16-32 h can attenuate the cerebral vasospasm by decreasing plasma and CSF ET-1 concentration and increasing plasma and CSF NO concentration, leading to the balance between cerebral vascular constriction and dilatation.

作者王志萍陈红生王凤祥

机构地区徐州医学院附属医院麻醉科江苏省麻醉医学研究所

出处《中华麻醉学杂志》 CAS CSCD 北大核心 2010年第2期209-212,共4页 Chinese Journal of Anesthesiology

基金江苏省卫生厅资助项目（H200723）江苏省医学重点人才资助项目（RC2007093）江苏省高校自然科学重大基础研究项目（08KJA320001）

关键词低温人工蛛网膜下腔出血血管痉挛颅内 Hypothermia, induced Subarachnoid hemorrhage Vasospasm, intracranial

分类号 R743.35 [医药卫生—神经病学与精神病学]

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