多次缺血预处理诱导脑侧枝循环重建对脑缺血保护的实验
研究
孟祥忠;徐浩;韩丽春;宋博;高巍;马秦;徐礼鲜
【期刊名称】《国际麻醉学与复苏杂志》 【年(卷),期】2011(032)004
【摘要】目的采用多次压迫阻断右侧颈总动脉的缺血预处理，并逐次递增缺血时间，诱导右侧大脑侧枝循环建立，观察其对脑缺血的保护作用。方法家兔48只，采用随机数字法分为对照组和实验组，每组24只。实验组实验期间实施球囊充气阻断颈动脉血流，每次压迫时间为：次缺血时间=次数×5+40(min)进行，每日2次，直到压迫时间达4 h（总时间为20d）。对照组其他操作同实验组，但实验期间不阻断颈动脉血流。各组分别在实验开始后第1、10、20天，分别进行数字剪影脑血管造影(digital subtraction angiography,DSA)，观察家兔右侧大侧枝循环建立情况；并于实验第20天，球囊充气持续完全阻断右侧颈总动脉血流，1、3、6、24h观察记录家兔神经功能缺失评分；24h后取脑组织标本，光镜下对比观察两组相同部位的病理学及新生血管数量的变化，并比较两组缺血侧脑组织含水量。 结果实验期间两组家兔之间均没有观察到兴奋、躁动、嗜睡等异常症状。DSA显像结果表明，实验组在第10天，造影剂已经通过大脑动脉环（Willis环）进入右侧大脑动脉，与压迫第1天比较右侧血管显影非常清晰，但与左侧比较右后外上段侧枝未见显影。在实施压迫处理的第20天,DSA血管显像左右两侧几乎无差异，右后外上段血管显影也非常清晰。神经功能缺失评分和脑组织含水量实验组明显小于对照组(P＜0.05)。右侧（缺血侧）病理标本，在400倍镜一个视野下的毛细血管密度，实验组为
5.3±0.5，对照组为3.5±0.4，实验明显多于对照组(P＜0.05)。结论多次缺血预处理能够诱导大脑Willis环及其相应的侧枝循环重建，对颈总动脉完全阻断的脑缺血具有明显的保护作用。%Objective We used ischemic preconditioning method by blocking rabbit's right carotid artery at intervals repeatedly and increasing blocking time to reconstruct collateral circulation. Cerebral protection effects were investigated after the right carotid artery was permanently blocked. Methods 48 rabbits were randomly divided into experimental and control groups (n=24).The right common carotid artery of the animals in the experimental group was compressed at intervals repeatedly. We blocked the right carotid artery blood flow by the Inflatable balloon, ischemic time=number of times×5+40(min), 2 times per day. The longest blocking time is 4 h (20th days). The procedure of control group was the same as that of experimental group, except that the carotid artery blood flow was not blocked. The establishment of a right collateral circulation in the rabbit brain was observed with Digital Subtraction Angiography (DSA) on the 1st, 10th and 20th day respectively. The blood flow in the right common carotid artery was completely blocked at 20th day. The neurological deficit score was observed at 1, 3, 6, 24 h. Then we got brain tissue specimens and compared the brain water content and pathological changes between the two groups. The number of brain microvascular of the
corresponding places was also counted. Results During the experiment, no abnormal behaviors such as excitement, agitation, lethargy were observed in either group. DSA showed that contrast medium passed into the right middle cerebral artery Willis ring on the 10th day.Compared with the 1st day, the blood vessels on the right side were much clearer in DSA. On the 20th day there was almost no difference between the left and right sides in vascular imaging. Experimental group's neurological deficit score and water content were lower than those of the control group's (P＜0.05). Observation showed that there were more brain microvascular in the right side (ischemic side) pathological specimens of the experimental group 5.3±0.5 than control group 3.5±0.4 (P＜O.05) under microscope at 400 times. Conclusion By multiple ischemic preconditioning cerebral artery Willis ring and cerebral collateral circulation would be reconstructed, and it had obvious protective effect on cerebral ischemia resulted from completely blocked carotid arteries. 【总页数】5页(385-388,416)
【关键词】多次缺血预处理;侧枝循环;神经功能缺失评分；脑缺血 【作者】孟祥忠;徐浩;韩丽春;宋博;高巍;马秦;徐礼鲜
【作者单位】710032 西安，第四军医大学口腔医院麻醉科;710032 西安，第四军医大学口腔医院麻醉科;陕西省肿瘤医院麻醉科;710032 西安，第四军医大学口腔医院麻醉科;710032 西安，第四军医大学口腔医院麻醉科;第四军医大学
多次缺血预处理诱导脑侧枝循环重建对脑缺血保护的实验研究
