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，为心源性脑栓塞急性期行体外循环心脏手术的基础研究提供可靠的动物模型。方法54只兔采用完全随机设计方法等分成A、B1、B2三组，A组为非脑栓塞CPB组（n＝18），B1、B2组统归于B大组，即脑栓塞CPB组，B1组为脑栓塞24 h后CPB组（n＝18），B2组为脑栓塞一周后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、B2两组兔MCAO术后存活率100%，24 h、1周后MRI检查均见相应供血区域的异常高信号；在建立CPB模型成功率方面，A组（94.4%）与B大组（80.5%）无显著差异（χ2＝1.83，0.10＜P＜0.25）；B1组（72.2%）与B2组（88.9%）也无显著差异（P＝0.402，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，위심원성뇌전새급성기행체외순배심장수술적기출연구제공가고적동물모형。방법54지토채용완전수궤설계방법등분성A、B1、B2삼조，A조위비뇌전새CPB조（n＝18），B1、B2조통귀우B대조，즉뇌전새CPB조，B1조위뇌전새24 h후CPB조（n＝18），B2조위뇌전새일주후CPB조（n＝18）。경광상연입로，직시하전응좌측대뇌중동맥주간，건립토대뇌중동맥뇌전새（middle cerebral artery occlusion， MCAO）모형，병분별우뇌전새24 h、1주진행MRI검사，관찰각조뇌전새정황。흉골정중절구，승주동맥화우심방분별삽관，건립CPB，종이건립뇌전새급성기CPB모형。관찰각조건모성공솔，병우CPB후2 h진행MRI검사관찰뇌부정황。결과 B1、B2량조토MCAO술후존활솔100%，24 h、1주후MRI검사균견상응공혈구역적이상고신호；재건립CPB모형성공솔방면，A조（94.4%）여B대조（80.5%）무현저차이（χ2＝1.83，0.10＜P＜0.25）；B1조（72.2%）여B2조（88.9%）야무현저차이（P＝0.402，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 the phase of cerebral embolism, in order to provide an reliable animal model for the fundamental research of cardiac surgery with CPB in the acute phase of cardiogenic cerebral embolism. Methods 54 rabbits were randomly divided into three groups. Group A (n=18) underwent an operation of CPB without MCAO(middle cerebral artery occlusion);Group B1 (n=18) underwent an operation of CPB at 24 h after MCAO;Group B2 (n=18) underwent an operation of CPB at 1 week after MCAO; furthermore, group B1 and B2 belong to group B. Through supraorbital margin approach, electrocoagulation was carried out to occlude the main stem of the left MCA under direct vision, MCAO model was established. And MRI was performed at 24 h, 1 week after MCAO respectively. The severity of cerebral embolization was evaluated. Through a median sternotomy incision, CPB was established with the ascending aorta cannulation and the right atrium cannulation. Thus, the model of CPB in acute cerebral embolism phase (at 24 h, 1 week after MCAO) was established. The model making success rate was observed in each group, and the brain was examined by MRI at 2 h after CPB. Results All rabbits in B1 and B2 groups survived after MCAO surgery, with abnormal high signal presenting in the Magnetic Resonance Imaging (MRI) at 24 h or 1week postoperatively. In the CPB model making success rate, insignificant differences were observed between group A(94.4%) and group B (80.5%)(χ2=1.83, 0.10<P<0.25), as well as between group B1(72.2%) and group B2(88.9%)(P=0.402, P>0.05). Through MRI examination, no cerebral hemorrhage or new embolism was detected at 2 h after CPB in group A and group B. Conclusions It is high-success rate, stable and feasible CPB model of a rabbit of acute cerebral embolism that established by adopting supraorbital margin approach and simulating clinical practice. And it is the ideal model for the study of mechanism of CPB related organ damage and its intervention. There are not cerebral hemorrhage and new embolism detected after CPB in acute cerebral embolism phase (at 24 h, 1week after MCAO).