中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2010年
1期
57-60
,共4页
脑出血%微创血肿清除术%神经元特异性烯醇化酶%凋亡细胞
腦齣血%微創血腫清除術%神經元特異性烯醇化酶%凋亡細胞
뇌출혈%미창혈종청제술%신경원특이성희순화매%조망세포
Cerebral hemorrhage%Minimal invasive operation%Neuron-specific-enolase%Apoptotic cells
目的 以神经功能缺损评分、神经元特异性烯醇化酶及凋亡细胞为指标,观察微创颅内血肿清除术治疗脑出血的疗效.方法 采用20只家犬为实验材料,以自体动脉血注入尾状核的方式制作脑出血模型,以头颅CT扫描发现基底节区高密度影为模型制作成功的标志.脑出血模型制作成功后将20只家犬分为两组(随机数字法)进行实验:(1)对照组10只,造模成功后予内科治疗,不进行血肿清除;(2)微创组10只,造模6 h内进行微创穿刺粉碎清除术清除颅内血肿.分别在清除血肿后1,3,5,7 d对各组动物进行神经功能缺损评分、血清神经元特异性烯醇化酶检测,术后第7天处死动物,取血肿周围脑组织进行凋亡细胞计数.各组动物神经功能缺损评分、神经元特异性烯醇化酶含量的分析用重复测量设计的方差分析方法,凋亡细胞计数比较则运用析因设计的方差分析方法,组间差异用q检验,P<0.05为差异具有统计学意义.结果 微创组在清除血肿后1,3,5,7 d神经功能缺损评分别为(6.3±1.702),(5.8±1.685),(4.2±1.762)和(4.1±1.875),与对照组(8.9±1.632),(8.6±1.342),(7.8±1.335),(7.9±1.468)比较,差异具有统计学意义(P<0.01);微创组神经元特异性烯醇化酶分别为(0.632±0.077),(0.721±0.771),(0.549±0.124)和(0.430±0.136),对照组为(0.934±0.064),(0.997±0.075),(0.986±0.042),(0.874±0.165),与对照组相比,微创组神经元特异性烯醇化酶含量明显减少(P<0.01);微创组血肿周围脑组织神经元凋亡细胞计数(37.4个)明显少于对照组(88.6个),差异均有统计学意义(P<0.01).结论 通过微创方法清除颅内血肿可明显减轻神经功能的损伤程度,减少神经细胞的损伤和血肿周围凋亡细胞数量.
目的 以神經功能缺損評分、神經元特異性烯醇化酶及凋亡細胞為指標,觀察微創顱內血腫清除術治療腦齣血的療效.方法 採用20隻傢犬為實驗材料,以自體動脈血註入尾狀覈的方式製作腦齣血模型,以頭顱CT掃描髮現基底節區高密度影為模型製作成功的標誌.腦齣血模型製作成功後將20隻傢犬分為兩組(隨機數字法)進行實驗:(1)對照組10隻,造模成功後予內科治療,不進行血腫清除;(2)微創組10隻,造模6 h內進行微創穿刺粉碎清除術清除顱內血腫.分彆在清除血腫後1,3,5,7 d對各組動物進行神經功能缺損評分、血清神經元特異性烯醇化酶檢測,術後第7天處死動物,取血腫週圍腦組織進行凋亡細胞計數.各組動物神經功能缺損評分、神經元特異性烯醇化酶含量的分析用重複測量設計的方差分析方法,凋亡細胞計數比較則運用析因設計的方差分析方法,組間差異用q檢驗,P<0.05為差異具有統計學意義.結果 微創組在清除血腫後1,3,5,7 d神經功能缺損評分彆為(6.3±1.702),(5.8±1.685),(4.2±1.762)和(4.1±1.875),與對照組(8.9±1.632),(8.6±1.342),(7.8±1.335),(7.9±1.468)比較,差異具有統計學意義(P<0.01);微創組神經元特異性烯醇化酶分彆為(0.632±0.077),(0.721±0.771),(0.549±0.124)和(0.430±0.136),對照組為(0.934±0.064),(0.997±0.075),(0.986±0.042),(0.874±0.165),與對照組相比,微創組神經元特異性烯醇化酶含量明顯減少(P<0.01);微創組血腫週圍腦組織神經元凋亡細胞計數(37.4箇)明顯少于對照組(88.6箇),差異均有統計學意義(P<0.01).結論 通過微創方法清除顱內血腫可明顯減輕神經功能的損傷程度,減少神經細胞的損傷和血腫週圍凋亡細胞數量.
목적 이신경공능결손평분、신경원특이성희순화매급조망세포위지표,관찰미창로내혈종청제술치료뇌출혈적료효.방법 채용20지가견위실험재료,이자체동맥혈주입미상핵적방식제작뇌출혈모형,이두로CT소묘발현기저절구고밀도영위모형제작성공적표지.뇌출혈모형제작성공후장20지가견분위량조(수궤수자법)진행실험:(1)대조조10지,조모성공후여내과치료,불진행혈종청제;(2)미창조10지,조모6 h내진행미창천자분쇄청제술청제로내혈종.분별재청제혈종후1,3,5,7 d대각조동물진행신경공능결손평분、혈청신경원특이성희순화매검측,술후제7천처사동물,취혈종주위뇌조직진행조망세포계수.각조동물신경공능결손평분、신경원특이성희순화매함량적분석용중복측량설계적방차분석방법,조망세포계수비교칙운용석인설계적방차분석방법,조간차이용q검험,P<0.05위차이구유통계학의의.결과 미창조재청제혈종후1,3,5,7 d신경공능결손평분별위(6.3±1.702),(5.8±1.685),(4.2±1.762)화(4.1±1.875),여대조조(8.9±1.632),(8.6±1.342),(7.8±1.335),(7.9±1.468)비교,차이구유통계학의의(P<0.01);미창조신경원특이성희순화매분별위(0.632±0.077),(0.721±0.771),(0.549±0.124)화(0.430±0.136),대조조위(0.934±0.064),(0.997±0.075),(0.986±0.042),(0.874±0.165),여대조조상비,미창조신경원특이성희순화매함량명현감소(P<0.01);미창조혈종주위뇌조직신경원조망세포계수(37.4개)명현소우대조조(88.6개),차이균유통계학의의(P<0.01).결론 통과미창방법청제로내혈종가명현감경신경공능적손상정도,감소신경세포적손상화혈종주위조망세포수량.
Objective To observe the therapeutic effect of minimally invasive evacuation of intracerebral hematoma in dog model of cerebral hemorrhage by using Purdy score, serum levels of neuron-specific-enolase (NSE) and numbers of perihematomal apoptotic cells. Method Twenty dogs were selected to prepoxe the model of cerebral hemorrhage, and they were randomly divided( random number) into minimally invasive treatment group and control group. Minimally invasive procedures were performed to evacuate the hematoma in minimally invasive treatment group in 6 hours after the models were established. The dogs of control group only received medical treatment. Purdy score and serum levels of neuron-specific-enolase were determined on 1,3,5,7 days after the evacuation of the hemotoma and apoptotic cells were counted after the dogs were sacrificed at 7 days after operation. All the results were compared with control group. Purdy score and serum levels of neuron-specific-enolase were compaired with variance analysis of repeated measurement design and apoptotic cells was compared with variance analysis of factorial design,the difference of the two groups showed with q test. P <0.01 showed the difference was significant. Results The Purdy scores in minimally invasive treatment group were 6.3 ± 1.702, 5.8 ± 1. 685,4.2 ± 1.762 and 4.1 ± 1.875 on 1,3,5 and 7 day after evacuation of the hematoma, significant difference was observed as compared with the control group(8.9 ± 1.632, 8.6± 1.342, 7.8±1.335, 7.9±1.468, P <0.01).The serum levels of neuron-specific-enolase were 0.632 ± 0.077, 0.721±0.771, 0.549±0.124 and 0.430 ±0.136 respectively in minimally invasive treatment group, while in the control group were 0.934 ± 0. 064, 0. 997 ±0.075, 0.986 ± 0.042, 0.874 ± 0.165, significant differences in serum levels of neuron-specific-enolase were found between the two groups(P < 0.01). The perihematomal apoptotic cells in minimally invasive treatment group(37.4 cells) was decreased significantly as compared with the control group(88.6 cells), with P < 0.01.Conclusions Minimally invasive procedures for evacuation of intracerbral hematoma might significantly reduce the neurological deficit score and decrease the serum neuron-specific enolase levels and numbers of apeptotic neurons.
