CAJ | 학술논문

背景:血液稀释是血液保护的重要措施,目前已广泛应用于临床.有研究报道血液稀释可降低血液黏度、增加脑血流,具有脑保护作用.但同时也降低血氧含量,使这一保护作用受到限制. 目的:探讨中度急性等容血液稀释( acute normovolemic hemodilution, ANH)对大鼠局部脑缺血模型的脑血流和脑梗死面积的影响. 设计:完全随机对照实验研究. 地点和材料:本研究的地点在北京市神经外科研究所,材料为健康成年雄性 Wistar大鼠 16只,体质量 300～ 350 g,为中国医学科学院动物中心提供的二级动物. 干预: 16只 Wistar大鼠单纯随机分为对照组( n=8)和 ANH组 (n=8),其中使 ANH组血细胞比容( hematocrit,HCT)降至 30.7%,两组分别阻塞左侧大脑中动脉.于缺血前和缺血 120 min内,用激光多普勒血流仪连续测定缺血周边皮层的局部脑血流( regional cerebral blood flow, rCBF)变化,以上部分由作者本人实施.缺血后 24 h,由不知道分组情况的人员测定脑梗死面积. 主要观察指标:两组动物生理指标的比较及血液稀释后的变化,两组脑缺血前后 rCBF的变化, TTC染色后两组脑梗死面积. 结果: ANH组在 ANH后, HCT从 47.28%降至 30.74%,动脉血氧含量( CaO2)从 (8.90± 0.57) mmol/L降至 (5.91± 0.74) mmol/L,与 ANH前和对照组比较 , 差异有非常显著性意义( P< 0.01).在脑缺血后,两组缺血周边区的 rCBF均显著下降( P< 0.01). ANH组的 rCBF降至基础值的 55.77%,对照组降至基础值的 28.50%,组间差异具有非常显著性意义( P < 0.01).缺血 24 h后的脑梗塞面积,在 ANH组为 40.01%,对照组为 51.19%,组间差异具有显著性意义( P< 0.05). 结论:中度 ANH可增加大鼠局部脑缺血模型的缺血周边区的 rCBF,缩小脑梗死面积,在脑缺血情况下具有脑保护作用.
배경:혈액희석시혈액보호적중요조시,목전이엄범응용우림상.유연구보도혈액희석가강저혈액점도、증가뇌혈류,구유뇌보호작용.단동시야강저혈양함량,사저일보호작용수도한제. 목적:탐토중도급성등용혈액희석( acute normovolemic hemodilution, ANH)대대서국부뇌결혈모형적뇌혈류화뇌경사면적적영향. 설계:완전수궤대조실험연구. 지점화재료:본연구적지점재북경시신경외과연구소,재료위건강성년웅성 Wistar대서 16지,체질량 300～ 350 g,위중국의학과학원동물중심제공적이급동물. 간예: 16지 Wistar대서단순수궤분위대조조( n=8)화 ANH조 (n=8),기중사 ANH조혈세포비용( hematocrit,HCT)강지 30.7%,량조분별조새좌측대뇌중동맥.우결혈전화결혈 120 min내,용격광다보륵혈류의련속측정결혈주변피층적국부뇌혈류( regional cerebral blood flow, rCBF)변화,이상부분유작자본인실시.결혈후 24 h,유불지도분조정황적인원측정뇌경사면적. 주요관찰지표:량조동물생리지표적비교급혈액희석후적변화,량조뇌결혈전후 rCBF적변화, TTC염색후량조뇌경사면적. 결과: ANH조재 ANH후, HCT종 47.28%강지 30.74%,동맥혈양함량( CaO2)종 (8.90± 0.57) mmol/L강지 (5.91± 0.74) mmol/L,여 ANH전화대조조비교 , 차이유비상현저성의의( P< 0.01).재뇌결혈후,량조결혈주변구적 rCBF균현저하강( P< 0.01). ANH조적 rCBF강지기출치적 55.77%,대조조강지기출치적 28.50%,조간차이구유비상현저성의의( P < 0.01).결혈 24 h후적뇌경새면적,재 ANH조위 40.01%,대조조위 51.19%,조간차이구유현저성의의( P< 0.05). 결론:중도 ANH가증가대서국부뇌결혈모형적결혈주변구적 rCBF,축소뇌경사면적,재뇌결혈정황하구유뇌보호작용.
BACKGROUND:Hemodilution is used widely in clinic as a method of blood conservation.It has been reported that hemodilution may ameliorate ischemia induced brain injury because it increases cerebral blood flow.However,it reduces arterial oxygen content as well.So hemodilution has limited success as a treatment of cerebral ischemia.OBJECTIVE:To assess the effects of moderate acute normovolemic hemodilution(ANH) on regional cerebral blood flow(rCBF) and cerebral infarct size in a rat model of focal cerebral ischemia. DESIGN:Completely randomized,controlled experiment. SETTING and PARTICIPANTS:Beijing Neurosurgical Institute.Sixteen male Wistar rats weighing 300-350 g were used. INTERVENTIONS:Sixteen Wistar rats were randomly assigned into two groups: control group(n=8) and ANH group(n=8).The hematocrit(HCT) of the animals in ANH group was reduced to about 30.7％ .The left middle cerebral artery(MCA) was exposed transcranially in both groups.The animals underwent permanent occlusion of the left middle cerebral artery(MCAO) with microbipolar forceps.Cortical rCBF was monitored in both groups before and during the initial 2-hour MCAO with laser Doppler flowmetry(LDF） .The infarct size of each brain was determined at 24 hours after MCAO by an experimenter who did not know the grouping.MAIN OUTCOME MEASURES:General physiological data collected in both groups.Changes of rCBF during the initial 2-hour MCAO in ANH group and cerebral infarct size at 24 hours after MCAO were assessed in both groups. RESULTS: In ANH group, hemodilution reduced HCT from 47.28％ to 30.74％ ,and CaO2 from(8.90± 0.57) mmol/L to(5.91± 0.74) mmol/L(P< 0.01).rCBF reduced to 55.77％ of baseline value in the ANH group and 28.5％ in the control group during the 2-hour MCAO.There was a significant difference between the two groups(P< 0.01).The total area of infarction was 40.01％ in the ANH group and 51.19％ in the control group.There was a significant difference between the two groups（ P< 0.05). CONCLUSION:Moderate ANH increases cortical rCBF and decreases brain infarct size in a rat model of focal ischemia. It has a protective effect on cerebral ischemia.