CAJ | 학술논문

目的：通过比较常规开颅减压和控制减压两种不同手术减压方式对治疗兔重型颅脑外伤后急性颅内高压脑组织中海人藻受体亚基5（GluR5）和海人藻受体亚基6（GluR6）的表达水平及脑组织微观病理变化，探讨控制减压技术治疗重型颅脑伤的可能机制，为控制减压手术方法在临床应用提供理论依据。方法采用硬膜外球囊加压方法制备兔重型颅脑外伤后急性颅内高压的动物模型，新西兰白兔随机分为假手术组、控制减压组和常规减压组，观察术后24 h GluR5和GluR6的表达情况、术后兔脑组织HE染色、术后24 h ICP变化情况及术后兔头颅CT的变化。结果术后24 h，控制减压组GluR5的表达明显高于常规减压组（P＜0．05），GluR6的表达明显低于常规减压组（P＜0．05）；脑组织HE染色控制减压组明显轻于常规减压组；控制减压组术后24 h ICP值明显低于常规减压组（P＜0．05）；控制减压组的脑梗塞发生率（10．5％）明显低于常规减压组（35．2％）（P＜0．05）。结论控制减压模式治疗兔重型颅脑外伤能有效减轻脑缺血再灌注损伤（ cerebral ischemia-reperfusion injury， I／R），降低术后脑梗塞等并发症发生率，起到明显的脑保护作用。
목적：통과비교상규개로감압화공제감압량충불동수술감압방식대치료토중형로뇌외상후급성로내고압뇌조직중해인조수체아기5（GluR5）화해인조수체아기6（GluR6）적표체수평급뇌조직미관병리변화，탐토공제감압기술치료중형로뇌상적가능궤제，위공제감압수술방법재림상응용제공이론의거。방법채용경막외구낭가압방법제비토중형로뇌외상후급성로내고압적동물모형，신서란백토수궤분위가수술조、공제감압조화상규감압조，관찰술후24 h GluR5화GluR6적표체정황、술후토뇌조직HE염색、술후24 h ICP변화정황급술후토두로CT적변화。결과술후24 h，공제감압조GluR5적표체명현고우상규감압조（P＜0．05），GluR6적표체명현저우상규감압조（P＜0．05）；뇌조직HE염색공제감압조명현경우상규감압조；공제감압조술후24 h ICP치명현저우상규감압조（P＜0．05）；공제감압조적뇌경새발생솔（10．5％）명현저우상규감압조（35．2％）（P＜0．05）。결론공제감압모식치료토중형로뇌외상능유효감경뇌결혈재관주손상（ cerebral ischemia-reperfusion injury， I／R），강저술후뇌경새등병발증발생솔，기도명현적뇌보호작용。
Objective The expressions of the kainic recepors ( GluR5 and GluR6 ) and the pathological changes of the brain tissues in rabbits with severe head trauma were compared between conventional decompression and controlled decompression groups to provide the experimental basis for the application of controlled decompression in clinical practices.Methods The animal model of rabbit with severe head trauma was established by epidural balloon compression method.New Zealand white rabbits were randomly divided into sham operation group, routine decompression group and controlled decompression group.The expressions of GluR5 and GluR6, HE staining of brain tissues, and the changes of skull CT 24 h post-operation were observed.Results At 24 h post-operation, the expression of GluR5 of controlled decompression group was significantly higher than that of conventional decompression group;the expression of GluR6 of conventional decompression group was obviously more than that of the controlled decompression group.HE staining of brain tissues of controlled decompression group was significantly better than that of conventional decompression group.ICP at 24 h post-operation in control pressure group was significantly lower than that of conventional decompression group.The incidence of cerebral infarction in the controlled decompression group (10.5%) was significantly lower than that of the conventional decompression group (35.2%).Conclusion Controlled decompression operation can effectively alleviate ischemia-reperfusion injury of brain tissues in rabbits with severe head trauma and reduce the post-operative complications, such as cerebral infarction, so it plays a protective role on brain tissues.