CAJ | 학술논문

目的：探索建立稳定、可行的兔脑栓塞急性期体外循环（cardiopulmonary bypass, CPB）模型，为研究临床脑栓塞急性期体外循环对脑组织的影响以及手术时机选择提供实验工具。方法54只兔随机分成A、B二大组，A组为非脑栓塞CPB组（n=18）， B组分为B1组（脑栓塞24 h后CPB组，n=18），B2组（脑栓塞1周后CPB组，n=18）。经眶上缘入路，直视下电凝左侧大脑中动脉主干，建立兔大脑中动脉脑栓塞（middle cerebral artery occlusion, MCAO）模型，并分别于脑栓塞24 h、1周进行MRI检查，观察各组脑栓塞情况。胸骨正中切口，升主动脉和右心房分别插管，建立CPB，从而建立脑栓塞急性期CPB模型。观察各组建模成功率，并于CPB后2 h进行MRI检查观察脑部情况。结果 B1、B2两组均成功建立脑栓塞模型，成功率100%，栓塞后兔均存活；A组和B组在建立CPB模型的成功率上无差异（P>0.05）。在CPB术后2 h，A、B两组MRI检查均未发现出血灶或新发栓塞灶。结论采用眶上缘入路及模拟临床实际建立的兔脑栓塞急性期体外循环模型具有成功率高、稳定、可行的特点，是进行脑栓塞急性期体外循环相关脏器损伤机制研究和对其进行干预的较理想模型。兔脑栓塞急性期进行体外循环后未见脑组织出血及新发栓塞灶。
목적：탐색건립은정、가행적토뇌전새급성기체외순배（cardiopulmonary bypass, CPB）모형，위연구림상뇌전새급성기체외순배대뇌조직적영향이급수술시궤선택제공실험공구。방법54지토수궤분성A、B이대조，A조위비뇌전새CPB조（n=18）， B조분위B1조（뇌전새24 h후CPB조，n=18），B2조（뇌전새1주후CPB조，n=18）。경광상연입로，직시하전응좌측대뇌중동맥주간，건립토대뇌중동맥뇌전새（middle cerebral artery occlusion, MCAO）모형，병분별우뇌전새24 h、1주진행MRI검사，관찰각조뇌전새정황。흉골정중절구，승주동맥화우심방분별삽관，건립CPB，종이건립뇌전새급성기CPB모형。관찰각조건모성공솔，병우CPB후2 h진행MRI검사관찰뇌부정황。결과 B1、B2량조균성공건립뇌전새모형，성공솔100%，전새후토균존활；A조화B조재건립CPB모형적성공솔상무차이（P>0.05）。재CPB술후2 h，A、B량조MRI검사균미발현출혈조혹신발전새조。결론채용광상연입로급모의림상실제건립적토뇌전새급성기체외순배모형구유성공솔고、은정、가행적특점，시진행뇌전새급성기체외순배상관장기손상궤제연구화대기진행간예적교이상모형。토뇌전새급성기진행체외순배후미견뇌조직출혈급신발전새조。
Objective To establish a stable and feasible rabbit model of cardiopulmonary bypass (CPB) in acute cerebral embolism phase for studying the effects of CPB on brain tissues and the timing of surgical intervention of acute cerebral embolism. Methods Fifty-four rabbits were randomized into group A (n=18) to receive CPB without middle cerebral artery occlusion (MCAO) and group B to undergo CPB at 24 h (group B1, n=18) or 1 week (group B2, n=18) after MCAO. Through a supraorbital margin approach, electrocoagulation was carried out to occlude the main stem of the left MCA under direct vision to establish MCAO. Magnetic resonance imaging (MRI) was performed at both 24 h and 1 week after MCAO, and the severity of cerebral embolization was evaluated. CPB was established by cannulation of the ascending aorta and the right atrium through a median sternotomy incision. MRI was performed at 2 h after CPB to observe the brain tissues. Results MCAO was successfully established in groups B1 and B2, and all the rabbits survived after MCAO. In both groups A and B, MRI examination detected no cerebral hemorrhage or new embolism 2 h after CPB. Conclusions We have established a stable and feasible CPB model in rabbits with acute cerebral embolism to allow study of the mechanisms of CPB-related organ damage and its interventions.