CAJ | 학술논문

目的利用磁共振波谱技术及磁共振弥散加权成像探讨高压氧治疗颅脑爆震伤不同时间段脑局部代谢及水分子运动的变化.方法 90只新西兰大白兔按随机数字表法分成对照组、创伤组和高压氧治疗组,后2组采用600 mg TNT当量纸雷管在兔脑上方6.5 cm垂直距离爆炸制作颅脑爆震伤模型,高压氧治疗组待生命体征稳定后即给予不同疗程的高压氧治疗.于模型制作后1 d、3 d、7 d、14d、21 d等时间点观察兔存活情况,磁共振波谱观察乙酰天门冬氨酸(NAA)/肌酸(Cr)、NAA/胆碱(Cho)+Cr随时间发展的演变过程,磁共振弥散加权成像观察表观弥散系数(ADC)值随时间发展的演变过程.结果创伤组NAA/Cr均值在损伤后明显下降,7 d后有所回升,高压氧治疗组NAA/Cr均值较创伤组高,比较差异有统计学意义(P＜0.05).创伤组NAA/Cho+Cr均值在损伤后即明显降低,高压氧治疗组NAA/Cho+Cr均值较创伤组高,比较差异有统计学意义(P＜0.05).创伤组兴趣区ADC值在1 d时明显下降,3 d后逐渐上升,高压氧治疗组ADC值均较创伤组高,比较差异有统计学意义(P＜0.05).结论高压氧可通过改善局部神经元代谢、抑制脑水肿、增强局部胶质增生修复等改善颅脑爆震伤的预后,伤后早期干预可能更有利.
목적 이용자공진파보기술급자공진미산가권성상탐토고압양치료로뇌폭진상불동시간단뇌국부대사급수분자운동적변화.방법 90지신서란대백토안수궤수자표법분성대조조、창상조화고압양치료조,후2조채용600 mg TNT당량지뢰관재토뇌상방6.5 cm수직거리폭작제작로뇌폭진상모형,고압양치료조대생명체정은정후즉급여불동료정적고압양치료.우모형제작후1 d、3 d、7 d、14d、21 d등시간점관찰토존활정황,자공진파보관찰을선천문동안산(NAA)/기산(Cr)、NAA/담감(Cho)+Cr수시간발전적연변과정,자공진미산가권성상관찰표관미산계수(ADC)치수시간발전적연변과정.결과 창상조NAA/Cr균치재손상후명현하강,7 d후유소회승,고압양치료조NAA/Cr균치교창상조고,비교차이유통계학의의(P＜0.05).창상조NAA/Cho+Cr균치재손상후즉명현강저,고압양치료조NAA/Cho+Cr균치교창상조고,비교차이유통계학의의(P＜0.05).창상조흥취구ADC치재1 d시명현하강,3 d후축점상승,고압양치료조ADC치균교창상조고,비교차이유통계학의의(P＜0.05).결론 고압양가통과개선국부신경원대사、억제뇌수종、증강국부효질증생수복등개선로뇌폭진상적예후,상후조기간예가능경유리.
Objective To evaluate the role of magnetic resonance spectroscopy (MRS) and diffusion-weighted MRI (DWI) in detecting regional cerebral metabolic changes and changes of water molecular motion in rabbits after explosive brain injury at different time points of injury after being treated with hyperbaric oxygen therapy. Methods Ninety New Zealand white rabbits were divided into control group, trauma group and hyperbaric oxygen treatment group. The injured models in the later 2 groups were established using 600 mg TNT equivalent of paper detonators in the rabbit brain at the top of 6.5 cm vertical distance. Rabbits in the trauma group and hyperbaric oxygen treatment group were sub-divided into 1, 3, 7, 14 and 21 d treatment groups, respectively. The survival of these rabbits was observed at these time points. Hyperbaric oxygen treatments lasting for 1, 3, 7, 14 and 21 d were given to each hyperbaric oxygen treatment sub-groups, respectively. Performance under MRS was detected and dynamic changes of N-acetylaspartate (NAA)/creatine (Cr) ratio and NAA/choline(Cho)+Cr value were observed with MRS. DWI was employed to detect the dynamic changes of apparent diffusion coefficient (ADC) values. Results The NAA/Cr ratio in the trauma group markedly decreased right after the injury and slightly rose 7 d after the injury. Compared with that in the trauma group, the NAA/Cr ratio in the hyperbaric oxygen treatment group was significantly increased (P＜0.05). The NAA/Cho+Cr value in the trauma group was markedly decreased right after the injury, while that in the hyperbaric oxygen treatment group was obviously increased as compared with that in the trauma group (P＜0.05). ADC values in the region of interest of the trauma group was decreased after 1 d of treatment and gradually increased after 3 d of treatment; the ADC values in the hyperbaric oxygen treatment group was obviously higher than those in the trauma group (P＜0.05). Conclusion Hyperbaric oxygen might improve the prognosis by improving local metabolism of neurons, inhibiting brain edema, and enhancing local gliosis repair;, ultra-early intervention (within one week of injury) may be much favorable for animals/patients after explosive brain injury.