中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
1期
1-5
,共5页
谭峰%陈杰%梁艳桂%李雁萍%王学文%蒙迪
譚峰%陳傑%樑豔桂%李雁萍%王學文%矇迪
담봉%진걸%량염계%리안평%왕학문%몽적
脑梗死%脑皮质损伤%脊髓损伤%远隔损害%电针刺激
腦梗死%腦皮質損傷%脊髓損傷%遠隔損害%電針刺激
뇌경사%뇌피질손상%척수손상%원격손해%전침자격
Cerebral infarction%Brain cortex injury%Spinal cord injury%Remote damage%Electroacupuncture
目的：观察电针对易卒中型肾性高血压大鼠（RHRSP）大脑中动脉闭塞（MCAO）后脑缺血/再灌注（I/R）不同时间点脑梗死灶体积与皮质、脊髓神经元数目的影响，探讨电针对脑梗死远隔损害的可能机制。方法将480只雄性SD大鼠行双肾双夹术复制RHRSP模型，采取尾动脉测压术筛选制模成功大鼠370只，按随机数字表法分为高血压组60只、假手术组60只，再将剩余制模成功大鼠用线栓法复制MCAO模型，采用Longa 5分制法，在动物麻醉清醒后进行神经功能缺损程度评分（NDS），分值在1～3分的大鼠纳入实验。共有190只大鼠MCAO制模成功，从中随机抽取10只进行2，3，5-氯化三苯基四氮唑（TTC）染色确定梗死范围，将剩余的180只MCAO大鼠按随机数字表法分为模型组、电针组、假针刺组，每组60只。假手术组仅进行手术创伤；电针组在制模当天选取督脉百会和大椎穴进行电针治疗，每日1次，共28 d；假针刺组选大椎、百会穴位处给予针灸针贴肤治疗。治疗后1、7、14、28 d分别处死各组大鼠，取大鼠脑组织进行尼氏染色，检测梗死灶体积与神经元数目。结果①脑组织梗死灶体积：高血压组、假手术组未发现有梗死灶。MCAO术后1 d、7 d，模型组、电针组和假针刺组大鼠脑梗死灶体积均逐渐增大〔1 d 3组分别为（12.36±0.11）%、（12.19±0.15）%、（12.24±0.16）%，7 d 3组分别为（20.01±0.24）%、（19.54±0.61）%、（19.77±0.25）%〕，14 d、28 d，模型组、电针组和假针刺组大鼠脑梗死灶体积均有缩小趋势〔14 d 3组分别为（17.18±0.23）%、（16.96±0.11）%、（17.08±0.62）%，28 d 3组分别为（14.38±0.21）%、（13.95±0.46）%、（14.29±0.37）%〕，但3组比较差异均无统计学意义（均P＞0.05）。②皮质区：MCAO术后1 d各组间皮质神经元数目比较差异均无统计学意义（均P＞0.05）。7、14、28 d，假手术组皮质神经元数目较高血压组增多，但差异无统计学意义（均P＞0.05）。与假手术组比较，模型组皮质神经元数目7 d后开始明显增多；与模型组比较，电针组皮质神经元数目明显增多（个/HP，7 d：75.48±2.41比68.78±1.42，14 d：61.32±2.60比48.78±1.41，28 d：53.65±1.46比28.78±1.21，均P＜0.05），假针刺组皮质神经元数目有所减少（7 d：67.75±1.43，14 d：47.50±1.25，28 d：27.50±1.25），但差异均无统计学意义（均P＞0.05）。③脊髓区：MCAO术后1、7、14 d，各组间脊髓神经元数目比较差异均无统计学意义（均P＞0.05）。术后28 d，与高血压组比较，假手术组脊髓神经元数目增多，但差异无统计学意义（P＞0.05）；与模型组比较，电针组和假针刺组脊髓神经元数目均增加（个/HP：21.32±1.60、16.17±1.05比15.02±1.18），电针组差异有统计学意义（P＜0.05），假针刺组差异无统计学意义（P＞0.05）。结论大鼠脑梗死后脊髓（颈髓）出现继发性神经元死亡，电针可减轻脑梗死远隔损害部位脊髓继发性神经元损伤，可能是电针对高血压大鼠脑I/R损伤保护作用的又一新机制。
目的：觀察電針對易卒中型腎性高血壓大鼠（RHRSP）大腦中動脈閉塞（MCAO）後腦缺血/再灌註（I/R）不同時間點腦梗死竈體積與皮質、脊髓神經元數目的影響，探討電針對腦梗死遠隔損害的可能機製。方法將480隻雄性SD大鼠行雙腎雙夾術複製RHRSP模型，採取尾動脈測壓術篩選製模成功大鼠370隻，按隨機數字錶法分為高血壓組60隻、假手術組60隻，再將剩餘製模成功大鼠用線栓法複製MCAO模型，採用Longa 5分製法，在動物痳醉清醒後進行神經功能缺損程度評分（NDS），分值在1～3分的大鼠納入實驗。共有190隻大鼠MCAO製模成功，從中隨機抽取10隻進行2，3，5-氯化三苯基四氮唑（TTC）染色確定梗死範圍，將剩餘的180隻MCAO大鼠按隨機數字錶法分為模型組、電針組、假針刺組，每組60隻。假手術組僅進行手術創傷；電針組在製模噹天選取督脈百會和大椎穴進行電針治療，每日1次，共28 d；假針刺組選大椎、百會穴位處給予針灸針貼膚治療。治療後1、7、14、28 d分彆處死各組大鼠，取大鼠腦組織進行尼氏染色，檢測梗死竈體積與神經元數目。結果①腦組織梗死竈體積：高血壓組、假手術組未髮現有梗死竈。MCAO術後1 d、7 d，模型組、電針組和假針刺組大鼠腦梗死竈體積均逐漸增大〔1 d 3組分彆為（12.36±0.11）%、（12.19±0.15）%、（12.24±0.16）%，7 d 3組分彆為（20.01±0.24）%、（19.54±0.61）%、（19.77±0.25）%〕，14 d、28 d，模型組、電針組和假針刺組大鼠腦梗死竈體積均有縮小趨勢〔14 d 3組分彆為（17.18±0.23）%、（16.96±0.11）%、（17.08±0.62）%，28 d 3組分彆為（14.38±0.21）%、（13.95±0.46）%、（14.29±0.37）%〕，但3組比較差異均無統計學意義（均P＞0.05）。②皮質區：MCAO術後1 d各組間皮質神經元數目比較差異均無統計學意義（均P＞0.05）。7、14、28 d，假手術組皮質神經元數目較高血壓組增多，但差異無統計學意義（均P＞0.05）。與假手術組比較，模型組皮質神經元數目7 d後開始明顯增多；與模型組比較，電針組皮質神經元數目明顯增多（箇/HP，7 d：75.48±2.41比68.78±1.42，14 d：61.32±2.60比48.78±1.41，28 d：53.65±1.46比28.78±1.21，均P＜0.05），假針刺組皮質神經元數目有所減少（7 d：67.75±1.43，14 d：47.50±1.25，28 d：27.50±1.25），但差異均無統計學意義（均P＞0.05）。③脊髓區：MCAO術後1、7、14 d，各組間脊髓神經元數目比較差異均無統計學意義（均P＞0.05）。術後28 d，與高血壓組比較，假手術組脊髓神經元數目增多，但差異無統計學意義（P＞0.05）；與模型組比較，電針組和假針刺組脊髓神經元數目均增加（箇/HP：21.32±1.60、16.17±1.05比15.02±1.18），電針組差異有統計學意義（P＜0.05），假針刺組差異無統計學意義（P＞0.05）。結論大鼠腦梗死後脊髓（頸髓）齣現繼髮性神經元死亡，電針可減輕腦梗死遠隔損害部位脊髓繼髮性神經元損傷，可能是電針對高血壓大鼠腦I/R損傷保護作用的又一新機製。
목적：관찰전침대역졸중형신성고혈압대서（RHRSP）대뇌중동맥폐새（MCAO）후뇌결혈/재관주（I/R）불동시간점뇌경사조체적여피질、척수신경원수목적영향，탐토전침대뇌경사원격손해적가능궤제。방법장480지웅성SD대서행쌍신쌍협술복제RHRSP모형，채취미동맥측압술사선제모성공대서370지，안수궤수자표법분위고혈압조60지、가수술조60지，재장잉여제모성공대서용선전법복제MCAO모형，채용Longa 5분제법，재동물마취청성후진행신경공능결손정도평분（NDS），분치재1～3분적대서납입실험。공유190지대서MCAO제모성공，종중수궤추취10지진행2，3，5-록화삼분기사담서（TTC）염색학정경사범위，장잉여적180지MCAO대서안수궤수자표법분위모형조、전침조、가침자조，매조60지。가수술조부진행수술창상；전침조재제모당천선취독맥백회화대추혈진행전침치료，매일1차，공28 d；가침자조선대추、백회혈위처급여침구침첩부치료。치료후1、7、14、28 d분별처사각조대서，취대서뇌조직진행니씨염색，검측경사조체적여신경원수목。결과①뇌조직경사조체적：고혈압조、가수술조미발현유경사조。MCAO술후1 d、7 d，모형조、전침조화가침자조대서뇌경사조체적균축점증대〔1 d 3조분별위（12.36±0.11）%、（12.19±0.15）%、（12.24±0.16）%，7 d 3조분별위（20.01±0.24）%、（19.54±0.61）%、（19.77±0.25）%〕，14 d、28 d，모형조、전침조화가침자조대서뇌경사조체적균유축소추세〔14 d 3조분별위（17.18±0.23）%、（16.96±0.11）%、（17.08±0.62）%，28 d 3조분별위（14.38±0.21）%、（13.95±0.46）%、（14.29±0.37）%〕，단3조비교차이균무통계학의의（균P＞0.05）。②피질구：MCAO술후1 d각조간피질신경원수목비교차이균무통계학의의（균P＞0.05）。7、14、28 d，가수술조피질신경원수목교고혈압조증다，단차이무통계학의의（균P＞0.05）。여가수술조비교，모형조피질신경원수목7 d후개시명현증다；여모형조비교，전침조피질신경원수목명현증다（개/HP，7 d：75.48±2.41비68.78±1.42，14 d：61.32±2.60비48.78±1.41，28 d：53.65±1.46비28.78±1.21，균P＜0.05），가침자조피질신경원수목유소감소（7 d：67.75±1.43，14 d：47.50±1.25，28 d：27.50±1.25），단차이균무통계학의의（균P＞0.05）。③척수구：MCAO술후1、7、14 d，각조간척수신경원수목비교차이균무통계학의의（균P＞0.05）。술후28 d，여고혈압조비교，가수술조척수신경원수목증다，단차이무통계학의의（P＞0.05）；여모형조비교，전침조화가침자조척수신경원수목균증가（개/HP：21.32±1.60、16.17±1.05비15.02±1.18），전침조차이유통계학의의（P＜0.05），가침자조차이무통계학의의（P＞0.05）。결론대서뇌경사후척수（경수）출현계발성신경원사망，전침가감경뇌경사원격손해부위척수계발성신경원손상，가능시전침대고혈압대서뇌I/R손상보호작용적우일신궤제。
Objective To observe the effect of electric acupuncture on the infarct volume and amount of cerebral cortex and spinal neuron at different times of cerebral ischemia/reperfusion(I/R)in stroke prone renovascular hypertensive rats(RHRSP)with middle cerebral artery occlusion(MCAO),and investigate the possible mechanisms of electric acupuncture on remote damage in ischemic stroke. Methods 480 male SPF Sprague-Dawley(SD)rats were duplicated to form the RHRSP models by clamping both kidneys. 370 successful ones were selected by taking the tail artery blood pressure,and divided into hypertension group and sham operation group(each n=60)by random number table method. The MCAO models were created by stringing middle cerebral artery in the remaining RHRSP. The nerve function defect score(NDS)was graded by Longa 5 point method after the rats waked up from anesthesia,then the ones scored 1-3 were enrolled. Totally,there were 190 rats with MCAO successfully created from which 10 were randomly selected to determine the infarct size by 2,3,5-triphenyl four azole nitrogen chloride(TTC)staining. The remaining 180 MCAO rats were randomly divided into model group,electric acupuncture group and fake acupuncture group(each n=60). The sham operated group only received surgical trauma;the electrical acupunctures at"Baihui"and"Dazhui"acupoints on Du channel were performed on the day of model establishment in electric acupuncture group,once a day for 28 days;in fake acupuncture group,sticked the acupuncture needles at the skin of"Baihui"and"Dazhui"points,then gived the same electrical acupuncture treatment. On 1,7,14 and 28 days after treatment,the rats of each group were respectively sacrificed,and the brains were collected,then the infarct volume and spinal neuron number were calculated by Nissl staining. Results ①Cerebral infarction volume:No infarcts were found in hypertension group and sham operated group. On 1 day and 7 days after MCAO,the infarct volumes were increased gradually in model group,electric acupuncture group and fake acupuncture group〔infarct volumes on 1 day were(12.36±0.11)%, (12.19±0.15)%,(12.24±0.16)%,and on 7 days were(20.01±0.24)%,(19.54±0.61)%and(19.77±0.25)%, respectively〕,and on 14 days and 28 days after MCAO,the infarct volumes were decreased gradually〔infarct volumes on 14 days were(17.18±0.23)%,(16.96±0.11)%,(17.08±0.62)%,and on 28 days were(14.38±0.21)%, (13.95±0.46)% and(14.29±0.37)%,respectively〕,but the differences among three groups had no statistical significance(all P>0.05). ② Cortex area:On 1 day after MCAO,the differences in the cortical neuron numbers among all groups were not statistically significant(all P>0.05). On 7,14,28 days after MCAO,the cortical neuron number of sham operated group was more than that of hypertension group,but the difference had no statistical significance(all P>0.05). Compared with sham operated group,the cortical neuron number in model group began to increase significantly after 7 days;compared with model group,the cortical neuron number in electric acupuncture group was increased obviously(cell/HP,7 days:75.48±2.41 vs. 68.78±1.42,14 days:61.32±2.60 vs. 48.78±1.41,28 days:53.65±1.46 vs. 28.78±1.21,all P<0.05),while the cortex neuron number of fake acupuncture group was markedly reduced(7 days:67.75±1.43,14 days:47.50±1.25,28 days:27.50±1.25), but the differences had no statistical significance(all P>0.05).③Spinal cord area:On 1,7,14 days after MCAO, the differences of the spinal cord neuron numbers among all groups were not statistically significant(all P>0.05). On 28 days,compared with hypertension group,the cord neuron number of sham operated group was increased,but the difference had no statistical significance(P>0.05). Compared with model group,the cord neuron number in electric acupuncture and fake acupuncture groups was inecreased(cell/HP:21.32±1.60,16.17±1.05 vs. 15.02±1.18),the difference being statistical significant in electric acupuncture group(P<0.05)but no statistical significance in fake acupuncture group(P>0.05). Conclusions Generally,the secondary spinal(cervical part)neuron death occurs after cerebral infarction in rats. The therapeutic action of electric acupuncture may reduce the secondary spinal neuron damage at remote site after cerebral infarction,that is possibly the mechanism of electric acupuncture for the protection of brain in hypertensive rats from I/R injury.
