CAJ | 학술논문

背景:垂直与水平打击产生的受力不同造成破坏性病变程度是否一致?血液中的髓鞘碱性蛋白含量变化与打击形式是否有关联?目的:观察不同方向外力打击致兔颅脑损伤时血清髓鞘碱性蛋白浓度以及脑组织形态学变化.设计:随机对照实验.单位:一所医学院附属医院的神经外科.材料:实验于2003-10/2004-01在沈阳医学院中心实验室完成.选择健康家兔30只,雌雄不拘,随机分为垂直打击组和水平打击组,15只/组.方法:将全部家兔麻醉后俯卧位固定于多向颅脑损伤打击器的固定台上.分别抽取每只家兔的耳缘静脉血1 mL,用作受伤前髓鞘碱性蛋白对照.垂直打击组实施垂直打击,打击锤直接垂直撞击于颅顶骨上;水平打击组实施水平打击,打击锤水平撞击于兔头侧方.48 h后按相同方法制备两组血清,用作受伤后髓鞘碱性蛋白对照.最后将两组动物断头处死作病理检查.主要观察指标:①打击前后两组血清髓鞘碱性蛋白浓度的变化差异.②两组颅脑损伤后的病理形态变化差异.结果:按意向处理分析,30只动物均纳入实验.①两组家兔遭遇打击前髓鞘碱性蛋白浓度无明显差异.遭遇打击48 h后髓鞘碱性蛋白浓度垂直打击组与水平打击组亦无明显差异(P＞0.05);②垂直打击组髓鞘碱性蛋白打击前浓度明显低于打击后浓度[(1.68±0.86),(5.25±1.96)μg/L,t=3.226,P＜0.05];水平打击组髓鞘碱性蛋白打击前浓度明显低于打击后浓度[(1.70±0.91),(5.73±2.07)μg/L,t=3.080,P＜0.05].③打击后病理形态变化:垂直打击组双侧额顶近中线部位出现皮层脑组织内血管扩张充血,深层白质水肿,血管外和细胞外间隙明显扩大;水平打击组动物除双侧额顶近中线部位出现与垂直打击组相似变化外,相同的病理还可见于颅底面,但深层白质的病理形式与前者基本一致.结论:垂直或水平方向的外力打击均可造成脑损伤.打击前后髓鞘碱性蛋白浓度和打击后病理形态学表明这两种不同方向的外力打击使实验模型兔颅脑受损程度大致接近. 揹景:垂直與水平打擊產生的受力不同造成破壞性病變程度是否一緻?血液中的髓鞘堿性蛋白含量變化與打擊形式是否有關聯?目的:觀察不同方嚮外力打擊緻兔顱腦損傷時血清髓鞘堿性蛋白濃度以及腦組織形態學變化.設計:隨機對照實驗.單位:一所醫學院附屬醫院的神經外科.材料:實驗于2003-10/2004-01在瀋暘醫學院中心實驗室完成.選擇健康傢兔30隻,雌雄不拘,隨機分為垂直打擊組和水平打擊組,15隻/組.方法:將全部傢兔痳醉後俯臥位固定于多嚮顱腦損傷打擊器的固定檯上.分彆抽取每隻傢兔的耳緣靜脈血1 mL,用作受傷前髓鞘堿性蛋白對照.垂直打擊組實施垂直打擊,打擊錘直接垂直撞擊于顱頂骨上;水平打擊組實施水平打擊,打擊錘水平撞擊于兔頭側方.48 h後按相同方法製備兩組血清,用作受傷後髓鞘堿性蛋白對照.最後將兩組動物斷頭處死作病理檢查.主要觀察指標:①打擊前後兩組血清髓鞘堿性蛋白濃度的變化差異.②兩組顱腦損傷後的病理形態變化差異.結果:按意嚮處理分析,30隻動物均納入實驗.①兩組傢兔遭遇打擊前髓鞘堿性蛋白濃度無明顯差異.遭遇打擊48 h後髓鞘堿性蛋白濃度垂直打擊組與水平打擊組亦無明顯差異(P＞0.05);②垂直打擊組髓鞘堿性蛋白打擊前濃度明顯低于打擊後濃度[(1.68±0.86),(5.25±1.96)μg/L,t=3.226,P＜0.05];水平打擊組髓鞘堿性蛋白打擊前濃度明顯低于打擊後濃度[(1.70±0.91),(5.73±2.07)μg/L,t=3.080,P＜0.05].③打擊後病理形態變化:垂直打擊組雙側額頂近中線部位齣現皮層腦組織內血管擴張充血,深層白質水腫,血管外和細胞外間隙明顯擴大;水平打擊組動物除雙側額頂近中線部位齣現與垂直打擊組相似變化外,相同的病理還可見于顱底麵,但深層白質的病理形式與前者基本一緻.結論:垂直或水平方嚮的外力打擊均可造成腦損傷.打擊前後髓鞘堿性蛋白濃度和打擊後病理形態學錶明這兩種不同方嚮的外力打擊使實驗模型兔顱腦受損程度大緻接近.
배경:수직여수평타격산생적수력불동조성파배성병변정도시부일치?혈액중적수초감성단백함량변화여타격형식시부유관련?목적:관찰불동방향외력타격치토로뇌손상시혈청수초감성단백농도이급뇌조직형태학변화.설계:수궤대조실험.단위:일소의학원부속의원적신경외과.재료:실험우2003-10/2004-01재침양의학원중심실험실완성.선택건강가토30지,자웅불구,수궤분위수직타격조화수평타격조,15지/조.방법:장전부가토마취후부와위고정우다향로뇌손상타격기적고정태상.분별추취매지가토적이연정맥혈1 mL,용작수상전수초감성단백대조.수직타격조실시수직타격,타격추직접수직당격우로정골상;수평타격조실시수평타격,타격추수평당격우토두측방.48 h후안상동방법제비량조혈청,용작수상후수초감성단백대조.최후장량조동물단두처사작병리검사.주요관찰지표:①타격전후량조혈청수초감성단백농도적변화차이.②량조로뇌손상후적병리형태변화차이.결과:안의향처리분석,30지동물균납입실험.①량조가토조우타격전수초감성단백농도무명현차이.조우타격48 h후수초감성단백농도수직타격조여수평타격조역무명현차이(P＞0.05);②수직타격조수초감성단백타격전농도명현저우타격후농도[(1.68±0.86),(5.25±1.96)μg/L,t=3.226,P＜0.05];수평타격조수초감성단백타격전농도명현저우타격후농도[(1.70±0.91),(5.73±2.07)μg/L,t=3.080,P＜0.05].③타격후병리형태변화:수직타격조쌍측액정근중선부위출현피층뇌조직내혈관확장충혈,심층백질수종,혈관외화세포외간극명현확대;수평타격조동물제쌍측액정근중선부위출현여수직타격조상사변화외,상동적병리환가견우로저면,단심층백질적병리형식여전자기본일치.결론:수직혹수평방향적외력타격균가조성뇌손상.타격전후수초감성단백농도화타격후병리형태학표명저량충불동방향적외력타격사실험모형토로뇌수손정도대치접근.
BACKGROUND: Whether horizontal and vertical impacts cause craniocerebral injury of the same degree, and whether serum myelin basic protein (MBP) changes is associated with the direction of impact have been scarcely addressed in previous studies.OBJECTIVE: To observe the change in the serum MBP levels and morphological changes of the brain tissue rabbits with craniocerebral injury resulting from impacts from different directions.DESIGN: A randomized controlled experiment.SETTING: Department of Neurosurgery of a hospital affiliated to a medical university.MATERIALS: This study was conducted in the Central Laboratory of Shenyang Medical College between October 2003 and January 2004. Totally 30 healthy rabbits of either sex were randomly divided into two equal groups to receive vertical and horizontal impact on the head.METHODS: All the rabbits were anesthetized and fixed in prone position onto a table equipped with a device for inducing impact on the head from different directions. Venous blood of 1 mL was taken from the edge of the ear of each rabbit for detecting MBP before injury. The rabbits in vertical impact group received the impact of a hammer falling directly on the parietal bone of the skull. In the horizontal group, the rabbits were subjected to horizontal impact on the lateral side of the skull. Forty-eight hours after the injury, venous blood were again taken for MBP measurement. The rabbits were then killed for pathological examination of the brain.MAIN OUTCOME MEASURES: Changes in serum MBP and pathomorphology of the brain tissues in the two groups after the impact.RESULTS: ① According to intention to treat analysis, all the 30 animals were involved in the experiment. There was no significant difference in serum MBP levels between the two groups before the impact, nor 48 hours after the impact( P ＞ 0.05). In the vertical impact group, serum MBP levels before the impact was( 1.68 ± 0. 86) μg/L, which was significantly lower than that after the impact[ (5.25 ± 1.96) μg/L, t = 3. 226, P ＜ 0. 05]. ② In the horizontal strike group, serum MBP also significantly increased from the level of( 1.70 ± 0.91 ) μg/L before impact to(5.73 ± 2.07) μg/L after that( t = 3. 080, P ＜ 0.05) . ③ After the impact, vasodilation and congestion in the cortex near the midline of the bilateral parietal region and edema in the deep layer of the white matter were observed in the vertical impact group, along with significant enlargement of the extravascular and extracellular space. In the horizontal group, similar changes except those near the midline of the bilateral parietal region took place after the impact; the same pathological changes were also observed in the basal plane, with nearly identical pathological changes in the deep layer of the white matter.CONCLUSION: Vertical and horizontal impacts can both result in almost identical brain injuries demonstrated by similar changes in serum MBP and the pathomorphology of the brain tissues after the impacts.