CAJ | 학술논문

目的探讨缝隙连接在失血性休克大鼠缺血性脑损伤延生复苏中的作用.方法采用出血未控制失血性休克+双侧颈动脉夹闭的方式制备模型.将制成模型的24只SD大鼠随机分为3组(n=8):传统复苏组(Ⅰ组),低温延生复苏组(Ⅱ组)和甘珀酸延生复苏组(Ⅲ组).模拟救援过程,将各动物模型分为创伤失血期(1期)、院前救援期(2期)、院内复苏期(3期)3个时期.分别记录各时点的LVSP、±dp/dtmax、MAP、HR、RR,记录大鼠输血复苏后的存活时间.取大鼠左侧脑组织观察大体标本,并取0.2 g测定ATP(化学发光法)、肿瘤坏死因子-α、白介素-6(ELISA 法);取海马区脑组织0.2 g测定凋亡细胞百分数.结果低温延生复苏可以显著增加复苏后的存活时间(P＜0.01),减少ATP的损耗(P＜0.05),减少炎症因子的释放(P＜0.05),显著减少海马区细胞的凋亡(P＜0.01);而甘珀酸延生复苏虽然能够显著增加复苏后的存活时间(P＜0.01)、维持较高的ATP水平和减少海马区细胞的凋亡(P＜0.05),但不能减少所有炎症因子的释放.结论低温及甘珀酸延生复苏的效果显著优于传统复苏,缝隙连接阻断剂可产生与低温相似的脑保护效果,缝隙连接在失血性休克大鼠缺血性脑损伤延生复苏中具有重要作用.
목적 탐토봉극련접재실혈성휴극대서결혈성뇌손상연생복소중적작용.방법 채용출혈미공제실혈성휴극+쌍측경동맥협폐적방식제비모형.장제성모형적24지SD대서수궤분위3조(n=8):전통복소조(Ⅰ조),저온연생복소조(Ⅱ조)화감박산연생복소조(Ⅲ조).모의구원과정,장각동물모형분위창상실혈기(1기)、원전구원기(2기)、원내복소기(3기)3개시기.분별기록각시점적LVSP、±dp/dtmax、MAP、HR、RR,기록대서수혈복소후적존활시간.취대서좌측뇌조직관찰대체표본,병취0.2 g측정ATP(화학발광법)、종류배사인자-α、백개소-6(ELISA 법);취해마구뇌조직0.2 g측정조망세포백분수.결과 저온연생복소가이현저증가복소후적존활시간(P＜0.01),감소ATP적손모(P＜0.05),감소염증인자적석방(P＜0.05),현저감소해마구세포적조망(P＜0.01);이감박산연생복소수연능구현저증가복소후적존활시간(P＜0.01)、유지교고적ATP수평화감소해마구세포적조망(P＜0.05),단불능감소소유염증인자적석방.결론 저온급감박산연생복소적효과현저우우전통복소,봉극련접조단제가산생여저온상사적뇌보호효과,봉극련접재실혈성휴극대서결혈성뇌손상연생복소중구유중요작용.
Objective To investigate the role of gap-junction in suspended animation for hemorrhagic shock with brain injury.Methods Twenty-four SD rats were made into models of uncontrolled hemorrhagic shock and occlusion of bilateral common carotid arteries and randomly divided into 3 equal groups:traditional resuscitation group(Group Ⅰ)undergoing traditional resuscitation,hypothermy resuscitation group(Group Ⅱ)undergoing temperature lowering by ice-cap,and carbenoxolone resuscitation group(Group Ⅲ)undergoing injection of carbenoxolone 50μg/200 g.The process was divided into 3 periods:traumatic hemorrhagic period(30 min),pre-hospital treatment period(60 min),and in-hospital cardiopulmonary resuscitation period(60 min).The levels of left ventfieular systolic pressure(LVSP),maximum change rate of left ventricular pressure rise and fall(±dp/dtmax),mean arterial pressure (MAP),heart rate(HR),and respiratory rate(RR)were recorded at the beginning and t11e end of traumatic hemorrhagic period(T1 and T2),the end of pre-hospital treatment period(T3),and the end of in-hospital cardiopulmonary resuscitation period(T4).The survival time was recorded after in-hospital cardiopulmonary resuscitation period.Then the left brain wag taken out and the hippocampal neurons apoptosis was observed by flow cytometry,chemiluminescence was used to detect the ATP.and IL-6 and tumor necrosis fatetor(TNF)-α were detected by enzyme linked immunosorbent assay(ELISA).Results The survival time ofGroupsⅡ andⅢwere(2.9±0.6)h and(2.6 ±1.0)h respectively,both significantly longer than that of Group Ⅰ[(1.4±0.3)h,both P＜0.01].The apoptotic rates of hippocampal neurons of GroupsⅡand Ⅲ were(72±6)%and(75±9)% respectively,both significantly lower than that of Group[(83±5)%,P＜0.05].The ATP levels in hippocampus of GroupsⅡandⅢ were(2.0±0.3)and (1.9±0.4)pg/g respectively,both significantly higher than that of Group Ⅰ[(1.4±0.5 Pg/g,beth P＜0.05).The TNF-αand IL-6 levels of Groups Ⅱwere (1.7±0.3)pg/g and(19±3)Pg/g respectively,beth significantly lower than those of Group Ⅰ[(2.2±0.6)and(24±3)pg/g respectively,beth P＜O.05].The IL-6 level of GroupⅢwas(26±4)pg/g,significantly higher than that of Group Ⅱ(P＜0.01).There were no significant difference between Groups ⅡandⅢin the values of survival time,hippocampal neuron apoptosis,dissipation of ATP,and liberation of TNF-α(all P＞0.05),but there was significant difference in IL-6(P＜0.01).Conclusion Both hypothermy resuscitation and carbenoxolone resuscitation protect the brain of cerebral ischemia on hemorrhagic shock with brain injury,and suggest that Gap junctions play an important role in suspended animation to treat hemorrhagic shock with brain injury.