CAJ | 학술논문

背景:蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)是引起SAH致死和致残的主要原因,其发病机制目前还不要十分清楚.既往临床及实验研究均提示中药在某种程度上可改变SAH后脑血流变性质,改善脑功能.目的:探讨活血化瘀中药(HXHY)脑伤泰对大鼠蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)后脑血流量(rCBF)及脑微血管构筑等方面的影响及其作用机制.设计:随机对照的试验.单位:解放军第三军医大学西南医院神经外科,解放军第四军医大学西京医院全军神经外科研究所.材料:实验在第三军医大学西南医院神经外科实验室和第三军医大学基础部中心实验室完成.选用288只雄性Wistar大鼠.方法:通过大鼠枕大池自体血注入法制备SAH和CVS模型,并在1,4,12,24 h,3,7,14 d及21 d等不同时相点,观测各组大鼠局部rCBF、病理变化、脑微血管构筑和BBB超微结构变化.主要观察指标:①大鼠皮质rCBF变化.②脑光镜下病理改变.③脑皮质微血管构筑.④BBB的超微变化.结果:SAH后大鼠的rCBF、病理变化、脑微血管构筑和BBB超微结构变化的动态变化符合CVS的发展规律,HXHY和尼莫地平(Nim)对上述改变有不同程度的改善.结论:SAH后局部rCBF的变化可可以反映该时期CVS的状态,HXHY和Nim可通过多种机制对CVS发挥作用,其中"细胞保护"作用可能更为重要.
배경:주망막하강출혈(SAH)후뇌혈관경련(CVS)시인기SAH치사화치잔적주요원인,기발병궤제목전환불요십분청초.기왕림상급실험연구균제시중약재모충정도상가개변SAH후뇌혈류변성질,개선뇌공능.목적:탐토활혈화어중약(HXHY)뇌상태대대서주망막하강출혈(SAH)후뇌혈관경련(CVS)후뇌혈류량(rCBF)급뇌미혈관구축등방면적영향급기작용궤제.설계:수궤대조적시험.단위:해방군제삼군의대학서남의원신경외과,해방군제사군의대학서경의원전군신경외과연구소.재료:실험재제삼군의대학서남의원신경외과실험실화제삼군의대학기출부중심실험실완성.선용288지웅성Wistar대서.방법:통과대서침대지자체혈주입법제비SAH화CVS모형,병재1,4,12,24 h,3,7,14 d급21 d등불동시상점,관측각조대서국부rCBF、병리변화、뇌미혈관구축화BBB초미결구변화.주요관찰지표:①대서피질rCBF변화.②뇌광경하병리개변.③뇌피질미혈관구축.④BBB적초미변화.결과:SAH후대서적rCBF、병리변화、뇌미혈관구축화BBB초미결구변화적동태변화부합CVS적발전규률,HXHY화니막지평(Nim)대상술개변유불동정도적개선.결론:SAH후국부rCBF적변화가가이반영해시기CVS적상태,HXHY화Nim가통과다충궤제대CVS발휘작용,기중"세포보호"작용가능경위중요.
BACKGROUND: Post-subarachnoid haemorrhage(SAH) cerebral vasospasm(CVS) is the main reason causing mortality and disability, which has unknown pathogenesis at present. Previous clinical and experimental researches indicate that Chinese herbs can to some extent change post-SAH cerebral blood rheological property to improve brain functions.OBJECTIVE: To investigate the impacts of Naoshangtai(NST), a huoxue huayu(HXHY) Chinese herb, on cerebral blood flow(rCBF) and the construction of cerebral microvessel after post-SAH CVS and its mechanism.DESIGN: A randomized controlled trialSETTING: Department of Neurosurgery, Southwest Hospital, the Third Military Medical University of Chinese PLA; Institute of Neurosurgery, Xijing Hospital, the Forth Military Medical University of Chinese PLA.MATERIALS: The study was performed in the laboratory of the department of Neurosurgery, Southwest Hospital of the Third Military Medical University of Chinese PLA and the central laboratory of the Basic Medicine Faculty of the Third Military Medical University of Chinese PLA. A total of 288 male Wistar rats were selected in the study.INTERVENTION: Occipital cistern self-blood injection method was used to prepare SAH and CVS rat model for the observations of rCBF, pathologic changes, construction of cerebra microvessel and the ultrastructural changes of blood-brain barrier(BBB) at different time point of 1 hour, 4 hours, 12hours, 24 hours, and 3 days, 7 days, 14 days and 21days.MAIN OUTCOME MEASURES: ① cortical rCBF changes in rats; ②pathologic changes of the brain under optical microscope; ③ the construction of cerebral cortical microvessel; ④ ultrastructural changes of BBB.RESULTS: The dynamical alterations of post-SAH rCBF, pathology, construction of cerebral microvessel and the ultrastructure of BBB were in accordance with the development regulation of CVS. HXHY and Nimodipine(Nim) could ameliorate to some extent the above alterations.CONCLUSION: Post-SAH local rCBF alterations could reflect CVS status. HYHY and Nim could affect CVS through multiple mechanisms, in which "cytoprotection" might be more important.