中华航海医学与高气压医学杂志
中華航海醫學與高氣壓醫學雜誌
중화항해의학여고기압의학잡지
CHINESE JOURNAL OF NAUTICAL MEDICINE AND HYPERBARIC MEDICINE
2013年
4期
228-231,248
,共5页
付宪华%方大钊%董楠%王伟杰%孙晓阳%丁涟沭
付憲華%方大釗%董楠%王偉傑%孫曉暘%丁漣沭
부헌화%방대쇠%동남%왕위걸%손효양%정련술
高压氧%谷氨酰胺%颅脑损伤
高壓氧%穀氨酰胺%顱腦損傷
고압양%곡안선알%로뇌손상
Hyperbaric oxygen%Glutamine%Traumatic brain injury
目的 观察高压氧(hyperbaric oxygen,HBO)联合谷氨酰胺(glutamine,GLN)治疗对创伤性脑损伤(traumatic brain injury,TBI)大鼠预后的影响.方法 清洁级雄性SD大鼠60只,在TBI模型建立前第7天,腹腔注射1％戊巴比妥钠(30 ～ 50 mg/kg)麻醉,左侧腹部切口分离胃大弯,建立肠内营养支持模型.术后适应性喂养6d,采用Feeney法建立大鼠TBI模型,随后按数字表法随机分为普通营养组(TBI组)、高压氧组(TBI+ HBO组)、谷氨酰胺组(TBI+ GLN组)和高压氧联合谷氨酰胺组(TBI+HBO+ GLN组),每组15只.TBI组、TBI+ HBO组TBI后3h输注普通肠内营养,TBI+ GLN组、TBI+HBO+ GLN组给予含有谷氨酰胺(100 g中含谷氨酰胺2 g)的加强营养,4组均给予4.25 kJ/ml的肠内营养液,要求等氮(1.8 g/kg)、等能量(1046 kJ/kg).TBI+ HBO组、TBI+ HBO+ GLN组在TBI后3h内进舱进行一次性HBO治疗,治疗压力0.15 MPa(1.5 ATA).于TBI后1、3、7d,应用原位末端标记法(TUNEL)测定大鼠脑损伤灶周围半影区的神经细胞凋亡率,ELISA法检测前白蛋白(rat-prealbumin,ratPA)浓度,平衡木实验检测神经功能,称重法测量大鼠体质量变化.结果 TBI+ HBO组TBI后1、3d,TBI+ HBO+ GLN组TBI后1、3、7d半影区的神经细胞凋亡率降低,与同期TBI组比较差异有统计学意义(P＜0.05或P＜0.01)；TBI+ GLN组半影区的神经细胞凋亡率降低,但与同期TBI组比较差异无统计学意义.TBI+ GLN组和TBI+ HBO+ GLN组TBI后7d血浆rat-PA浓度增高,与同期TBI组比较差异有统计学意义(P＜0.05或P＜0.01)；TBI+ HBO组TBI后7 d、TBI+ HBO+ GLN组TBI后3、7d神经功能改善明显,平衡木实验评分与同期TBI组比较差异有统计学意义(P＜0.05或P＜O.01)；各组各时间点体质量差异无统计学意义.TBI+ HBO+ GLN组神经细胞凋亡率降低、血浆rat-PA浓度增高、神经功能恢复最明显.结论 HBO联合GLN治疗TBI可有效降低神经细胞凋亡率,提高血浆rat-PA浓度,改善神经功能,从而起到改善预后的作用.
目的 觀察高壓氧(hyperbaric oxygen,HBO)聯閤穀氨酰胺(glutamine,GLN)治療對創傷性腦損傷(traumatic brain injury,TBI)大鼠預後的影響.方法 清潔級雄性SD大鼠60隻,在TBI模型建立前第7天,腹腔註射1％戊巴比妥鈉(30 ～ 50 mg/kg)痳醉,左側腹部切口分離胃大彎,建立腸內營養支持模型.術後適應性餵養6d,採用Feeney法建立大鼠TBI模型,隨後按數字錶法隨機分為普通營養組(TBI組)、高壓氧組(TBI+ HBO組)、穀氨酰胺組(TBI+ GLN組)和高壓氧聯閤穀氨酰胺組(TBI+HBO+ GLN組),每組15隻.TBI組、TBI+ HBO組TBI後3h輸註普通腸內營養,TBI+ GLN組、TBI+HBO+ GLN組給予含有穀氨酰胺(100 g中含穀氨酰胺2 g)的加彊營養,4組均給予4.25 kJ/ml的腸內營養液,要求等氮(1.8 g/kg)、等能量(1046 kJ/kg).TBI+ HBO組、TBI+ HBO+ GLN組在TBI後3h內進艙進行一次性HBO治療,治療壓力0.15 MPa(1.5 ATA).于TBI後1、3、7d,應用原位末耑標記法(TUNEL)測定大鼠腦損傷竈週圍半影區的神經細胞凋亡率,ELISA法檢測前白蛋白(rat-prealbumin,ratPA)濃度,平衡木實驗檢測神經功能,稱重法測量大鼠體質量變化.結果 TBI+ HBO組TBI後1、3d,TBI+ HBO+ GLN組TBI後1、3、7d半影區的神經細胞凋亡率降低,與同期TBI組比較差異有統計學意義(P＜0.05或P＜0.01)；TBI+ GLN組半影區的神經細胞凋亡率降低,但與同期TBI組比較差異無統計學意義.TBI+ GLN組和TBI+ HBO+ GLN組TBI後7d血漿rat-PA濃度增高,與同期TBI組比較差異有統計學意義(P＜0.05或P＜0.01)；TBI+ HBO組TBI後7 d、TBI+ HBO+ GLN組TBI後3、7d神經功能改善明顯,平衡木實驗評分與同期TBI組比較差異有統計學意義(P＜0.05或P＜O.01)；各組各時間點體質量差異無統計學意義.TBI+ HBO+ GLN組神經細胞凋亡率降低、血漿rat-PA濃度增高、神經功能恢複最明顯.結論 HBO聯閤GLN治療TBI可有效降低神經細胞凋亡率,提高血漿rat-PA濃度,改善神經功能,從而起到改善預後的作用.
목적 관찰고압양(hyperbaric oxygen,HBO)연합곡안선알(glutamine,GLN)치료대창상성뇌손상(traumatic brain injury,TBI)대서예후적영향.방법 청길급웅성SD대서60지,재TBI모형건립전제7천,복강주사1％무파비타납(30 ～ 50 mg/kg)마취,좌측복부절구분리위대만,건립장내영양지지모형.술후괄응성위양6d,채용Feeney법건립대서TBI모형,수후안수자표법수궤분위보통영양조(TBI조)、고압양조(TBI+ HBO조)、곡안선알조(TBI+ GLN조)화고압양연합곡안선알조(TBI+HBO+ GLN조),매조15지.TBI조、TBI+ HBO조TBI후3h수주보통장내영양,TBI+ GLN조、TBI+HBO+ GLN조급여함유곡안선알(100 g중함곡안선알2 g)적가강영양,4조균급여4.25 kJ/ml적장내영양액,요구등담(1.8 g/kg)、등능량(1046 kJ/kg).TBI+ HBO조、TBI+ HBO+ GLN조재TBI후3h내진창진행일차성HBO치료,치료압력0.15 MPa(1.5 ATA).우TBI후1、3、7d,응용원위말단표기법(TUNEL)측정대서뇌손상조주위반영구적신경세포조망솔,ELISA법검측전백단백(rat-prealbumin,ratPA)농도,평형목실험검측신경공능,칭중법측량대서체질량변화.결과 TBI+ HBO조TBI후1、3d,TBI+ HBO+ GLN조TBI후1、3、7d반영구적신경세포조망솔강저,여동기TBI조비교차이유통계학의의(P＜0.05혹P＜0.01)；TBI+ GLN조반영구적신경세포조망솔강저,단여동기TBI조비교차이무통계학의의.TBI+ GLN조화TBI+ HBO+ GLN조TBI후7d혈장rat-PA농도증고,여동기TBI조비교차이유통계학의의(P＜0.05혹P＜0.01)；TBI+ HBO조TBI후7 d、TBI+ HBO+ GLN조TBI후3、7d신경공능개선명현,평형목실험평분여동기TBI조비교차이유통계학의의(P＜0.05혹P＜O.01)；각조각시간점체질량차이무통계학의의.TBI+ HBO+ GLN조신경세포조망솔강저、혈장rat-PA농도증고、신경공능회복최명현.결론 HBO연합GLN치료TBI가유효강저신경세포조망솔,제고혈장rat-PA농도,개선신경공능,종이기도개선예후적작용.
Objective To investigate the effect of hyperbaric oxygen (HBO) combined with glutamine (GLN) on the prognosis of traumatic brain injury (TBI) in rats.Methods Seven days before the establishment of TBI model,60 SD rats were anesthetized with 1％ pentobarbital sodium (30-50 mg/kg)to establish the intestinal nutritional support model.Six days after gastrotomy,Feeney method was employed to establish the rat model of traumatic brain injury.Then,the animals were randomly divided into 4 groups:the traumatic brain injury group (the TBI group),the TBI + HBO group,the TBI + GLN (glutamine) group,and the TBI + HBO + GLN group,each consisting of 15 animals.The animals in the TBI group and the TBI + HBO group received routine intestinal nutritional support,3 hours after sustaining TBI,and the animals in the TBI + GLN group and the TBI + HBO + GLN group received fortified intestinal nutritional support (containing 2 g of GLN in 100 g feed).The animals in the TBI + HBO group and the TBI + HBO + GLN group were just given one session of HBO therapy,3 hours after TBI,at a pressure of 0.15 MPa(1.5 ATA).Then,at d 1,d 3 and d 7 after TBI,neuronal apoptosis rate of penumbra area was evaluated with in situ end labeling (TUNEL),and Enzyme Linked Immunosorbent Assay was applied to evaluate rat-PA concentrations.The nerve function of the animals was detected by using Balance beam assay and changes in their body mass were monitored with the weighing method.Results One day and 3 days after TBI,neuronal apoptosis rate of penumbra area for the animals of the TBI + HBO group decreased.One day,3 days and 7 days after TBI,neuronal apoptosis rate of penumbra area for the animals of the TBI + HBO + GLN group also decreased.Statistical significance could be noted,when it was compared with the TBI group (P ＜ 0.05 or P ＜ 0.01).Neuronal apoptosis rate of penumbra area for the animals of the TBI + GLN group also decreased,but without statistical significance.For the animals of the TBI + GLN group and the TBI + HBO + GLN,the serum concentration of rat-PA increased 7 days after TBI (P ＜ 0.05),however,statistical significance was seen,when it was compared with the TBI group at the same time points (P ＜ 0.05 or P ＜ 0.01).Nerve function improved significantly.Statistical significance could be seen in the scores of balance beam assay for the animals of the TBI + HBO group 7 days after TBI and the animals of the TBI + HBO + GLN group 3 and 7 days after TBI,when it was compared with the TBI group at the same time points (P ＜ 0.05 or P ＜ 0.01).No statistical significance was noted in the differences of body mass index (BMI).Neuronal apoptosis rate in the animals of the TBI + HBO + GLN group decreased,while serum concentration of rat-PA increased,with the neural function recovered most prominently.Conclusions HBO combined with glutamine in the treatment of TBI could effectively decrease neuronal apoptosis rate,increase serum concentration of rat-PA and improve neural function of the experimental animals,thus improving prognosis.
