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1.
亚低温治疗颅脑创伤患者颅内生化代谢动态研究   总被引:25,自引:2,他引:23  
目的应用微透析技术研究了24例颅脑创伤患者脑细胞间液中葡萄糖(Glu)、乳酸(Lac)、丙酮酸(Pyru)、甘油(Gly)、乳酸/葡萄糖比值(L/G)和乳酸/丙酮酸比值(L/P)的变化规律以及亚低温治疗的影响。方法将微透析导管分别插入患者脑创伤病灶半暗带区、相对正常脑组织区和腹部皮下组织,收集微透析液,灌流速度为0.3μl/min。1管透析液/h。平均收集时间为67.37±21.20h;收集的透析液用生化分析仪测定Glu、Lac、Pyru和Gly。结果(1)亚低温治疗较常温治疗可明显降低患者脑创伤病灶半暗带区GLY,明显升高L/P比值, 而Glu、Lac、Pyru、L/G与常温组无显著性差异;(2)亚低温治疗较常温治疗能显著降低相对正常的脑组织Glu、Lac含量和L/P比值,但对Pyru、L/G、Gly较常温组无显著性差异;(3)亚低温治疗较常温治疗可显著提高Glu含量,降低腹部组织Lac、Gly含量和L/G、L/P的比值,但对Pyru含量无明显调节作用。结论微透析技术提供了一种实时监测颅脑创伤患者脑和皮下组织细胞间液生化指标的手段,亚低温治疗能预防患者近损伤区细胞膜的进一步降解,对未受伤的脑组织和腹部组织具有更好的保护作用,从而防止继发性损害。  相似文献   

2.
目的探讨颅脑损伤患者脑细胞间液中葡萄糖(Glu)、乳酸(Lac)、丙酮酸(Pyru)、甘油(Gly)、一氧化氮(NO)含量的变化及其临床意义。方法将微透析导管分别插入患者病灶半暗带区、相对正常脑组织区和腹部皮下组织收集微透析液,用生化分析仪测定Glu、Lac、Pyru、Gly、NO的变化,并计算Lac与Glu(UG)及Lac与Pyru(L/P)之比值。结果病灶半暗带区脑组织中Glu、Pyru、Gly的含量及L/G、L/P比值与相对正常脑组织中的相应值无显著性差异(P〉0.05),Glu的含量和坍比值均明显低于腹腔皮下组织的相应值(P〈0.01),Lac和NO浓度则明显高于正常脑组织和腹部皮下组织(P〈0.01)。结论微透析技术提供了一种实时监测颅脑损伤患者脑细胞间液生化指标的手段。患者脑组织间液中的生化指标和NO的含量变化可能与其预后密切相关。  相似文献   

3.
应用微透析技术检测10例颅脑创伤患者的脑细胞间液(ECF)中乳酸/丙酮酸(L/P)、乳酸/葡萄糖(L/G)及甘泔(Gly)的浓度并探讨其意义。现将结果报告如下。  相似文献   

4.
目的应用微透析技术研究15例动脉瘤显微手术中临时阻断载瘤动脉前后患者脑细胞间液中葡萄糖、乳酸及乳酸/葡萄糖比值的变化规律。方法在开颅动脉瘤夹闭手术过程中,将微透析导管插入相应的脑皮质中,收集微透析液,灌流速度0.3μl/min,15例患者平均收集时间(2.56±0.32)h,收集的微透析液应用生化分析仪及相应试剂盒测定乳酸、葡萄糖含量。结果在动脉瘤临时阻断及夹闭之前乳酸、葡萄糖含量变化不明显,临时阻断后乳酸含量明显升高,而葡萄糖含量下降。结论应用微透析技术进行术中监测发现载瘤动脉临时阻断后对患者脑细胞间液物质生化代谢有影响,术中应尽量减少临时阻断并缩短阻断时间。  相似文献   

5.
脑损伤后脑细胞外液中糖代谢变化的微透析研究   总被引:4,自引:1,他引:3  
目的探讨微透析技术监测脑损伤局部细胞外液(ECF)中糖代谢指标变化的意义。方法应用微透析技术动态收集大鼠轻、重度脑损伤局部的ECF透析液,观察其葡萄糖含量([Glu]d)和乳酸含量([Lac]d)的变化。结果透析管插入引起[Glu]d和[Lac]d的变化很小(P>0.05)。脑损伤后[Glu]d下降,与对照组及损伤前相比,相差显著(P<0.05),且损伤越重其变化越显著(P<0.05)。而脑损伤后[Lac]d则上升,与对照组及损伤前相比,相差显著(P<0.05),且损伤越重,其变化亦越显著(P<0.05)。脑损伤后[Glu]d和[Lac]d的变化分别与脑组织含水量呈显著负相关(P<0.05)和显著正相关性(P<0.05)。结论微透析技术是一种理想的动态监测脑损伤局部生化改变的方法;利用该技术监测损伤区ECF中糖代谢指标的异常变化,可以作为判定脑损伤程度的重要依据。  相似文献   

6.
目的探讨谷氨酸(Glu)在大鼠脑损伤局部的异常释放以及其对乳酸(Lac)含量变化的影响。方法采用大鼠局部脑损伤动物模型,分为对照组、损伤组、干预组。伤前15min干预组注射Riluzole(一种Glu突触前释放抑制剂),损伤组注射等容量的生理盐水,对照组仅开骨窗不损伤脑。应用微透析技术检测各组伤后不同时间透析液中Glu含量([Glu]d)及Lac含量([Lac]d)变化。结果[Glu]d及[Lac]d在伤后15min、30min和45min干预组明显低于损伤组(P<0.05),而明显高于对照组(P<0.05);在伤后60min,损伤组仍明显高于对照组(P<0.05)。伤后不同时间[Glu]d和[Lac]d变化呈显著正相关(P<0.01)。结论脑损伤后受损脑组织细胞液中Glu水平的升高是Glu神经元末梢大量释放Glu所致,并继而引起了Lac的含量升高。  相似文献   

7.
微透析技术与颅脑损伤研究   总被引:1,自引:0,他引:1  
微透析是一种简单、安全、有效的生物化学采样技术。在颅脑损伤的动物实验中应用微透析技术已对脑组织间液的许多成分进行了研究 ,发现兴奋性氨基酸、乳酸、丙酮酸等成分成倍增高 ,糖下降。在颅脑损伤病人的脑组织间液中也发现了类似的病理生理变化。本文对微透析技术的原理、方法及其在颅脑损伤研究方面的应用现状进行综述。  相似文献   

8.
脑微透析(cerebral microdialysis,CMD)监测技术可连续监测活体脑细胞外液中的生化物质浓度,现已逐渐应用到动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)患者的临床监测中。通过对a SAH患者脑细胞外液葡萄糖、乳酸、丙酮酸、谷氨酸浓度以及乳酸/丙酮酸比值进行监测和分析,可初步判断a SAH患者的预后,对脑血管痉挛、迟发性脑缺血等继发性脑损伤进行预警,并可指导a SAH患者的个体化及目标化治疗。CMD监测已成为重症a SAH多模态监护的一个关键组成部分。本文对CMD在a SAH中的应用情况进行综述。  相似文献   

9.
目的 利用微透析技术观察颅脑创伤大鼠伤后2.5h内邻近受伤区侧脑室透析液中乳酸、脑血流量的变化及亚低温治疗效果。方法 28只Wistar雌性大鼠随机分为正常对照组、常温创伤组和亚低温治疗组。亚低温组动物于创伤后用冰袋进行全身降温,在脑温降至30℃并保持1h后,加热复温至37℃。将透析管插入邻近受伤区的侧脑室区,位于前囱后1.5mm,中线旁2.5mm,深度3.5mm;灌流速度为4μl/min,每30min采1管样本,后两组均于收集第2管样本后制作颅脑创伤动物模型,继续透析至2.5h。应用激光多普勒血流仪监测脑血流量的变化。结果 (1)对照组大鼠透析液中乳酸水平在各时限内差异无显著性意义(P>0.05);常温创伤组于伤后1.5h内乳酸水平明显升高,与对照组比较差异有显著性意义(P<0.01);亚低温组经低温治疗后,乳酸水平降低,与其余两组相比差异有显著性意义(均P<0.01)。(2)常温创伤组大鼠,仅在伤后20min时出现脑血流量减少,与对照组比较差异有显著性意义(P<0.05);而其余各时限与对照组比较差异均无显著性意义(P>0.05)。亚低温组经治疗后2h内脑血流量持续降低,与常温创伤组比较差异有显著性意义(P<0.05)。结论 亚低温治疗可降低损伤区周围脑组织血流量,加速大鼠神经细胞对乳酸的代谢,从而起到神经细胞保护作用。  相似文献   

10.
目的分析急性脑出血(intracerebral hemorrhage,ICH)患者动脉血糖(Glu)及乳酸(Lac)水平变化与应激性溃疡出血(stress ulceration and blooding,SUB)发生的相关性。方法连续入选2017-05—2019-05入住长治医学院附属和平医院神经重症监护室的64例存在SUB的脑出血患者(病例组)和64例年龄、性别、出血部位、脑内血肿大小程度(以体积分为小、中、大)相匹配的未存在SUB的脑出血患者(对照组)。收集所有受试者入院1 h内、出现SUB当天(对照组为对应住院时间)以及入院第14天(T1、T2、T3)的动脉血气中Lac及Glu值。结果 2组T1及T3时Glu、Lac水平差异无统计学意义,病例组SUB发生后Glu、Lac水平明显升高,程度分别为(1.28±2.68)mmol/L和(0.79±0.97)mmol/L,与对照组相比差异有统计学意义(P0.05)。结论血糖及乳酸水平变化与SUB的发生密切相关,两项指标联合检测为SUB的早期诊断提供可靠依据。  相似文献   

11.
环氧二十碳三烯酸(EETs)主要由细胞内花生四烯酸在细胞色素P450环氧化酶催化下产生,并可由可溶性环氧化物水解酶降解为活性较低的二羟基二十碳四烯酸。近年来研究发现,EETs在神经组织中具有抗炎症反应、抗动脉粥样硬化、抗细胞凋亡和促进血管生成等作用,已成为多种神经系统疾病防治的新靶点。脑出血是一种严重的急性脑血管疾病,继发性脑损伤是其重要损伤机制之一。目前研究证实EETs对脑出血后的脑组织具有保护作用,因此成为了脑出血防治研究的新热点。笔者现围绕EETs在脑出血中的作用及其机制的研究进展展开综述,以期为脑出血治疗中新的研究方向及治疗靶点的探索提供一定参考。  相似文献   

12.
目的探究N-3多不饱和脂肪酸水平与脑出血之间的关系。方法选取2013年5月至2014年12月于本院确诊为急性期脑出血患者70例作为A组,经年龄和性别匹配后的常规心脑血管病患者70例作为B组。记录患者的临床常规参数包括身高和血压等,及血液生化参数包括血清谷草转氨酶(AST)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、二十碳五烯酸(EPA)及花生四烯酸(AA)浓度等。二元Logistic回归分析方法用于识别脑出血的关键危险因素。结果与B组相比,A组患者具有较高的舒张压和酒精摄入量(400 m L/d),较低的体质指数、HDL-C、EPA(54.3±3.2 vs 81.6±4.9 mg/m L,P0.001)、EPA/AA比(0.33±0.12 vs 0.49±0.18,P0.001)、蔬菜摄入(100 g/wk)及抗高血压药使用(P0.05)。Logistic回归分析显示较高的舒张压和酒精(400 m L/d),较低的BMI、HDL-C、EPA/AA比(风险比:0.06,P0.05)及蔬菜摄入(100 g/wk)是患者颅内脑出血的显著危险因素。高水平HDL-C是性别亚组(风险比:0.93和0.85,P0.05和P0.001)和年龄65岁亚组(风险比:0.80,P0.005)患者的共同危险因素,而低水平EPA(风险比:0.96,P0.001)是≥65岁亚组患者的危险因素。结论低水平EPA浓度和EPA/AA比是脑出血的关键危险因素,尤其对于年龄≥65岁老年患者。  相似文献   

13.
GABA-transminase (GABA-T) activity of fresh frozen coronal sections through rat striatum was evaluated 4–6 weeks after intrastriatal application of kainic or ibotenic acid. 16 μm sections were processed for GABA-T histochemistry and were evaluated quantitatively by computerized densitometry using image analysis. Alternate sections (200 μm) were assayed for GABA-T activity in vitro. Gross examination of sections stained for GABA-T revealed obvious lack of staining in the vicinity of lesions produced by either kainate (0.5–1.0 μg) or ibotenate (10–20 μg); the extent of each lesion was clearly delineated by the stain. Quantitative analysis of stained sections revealed that the lesioned tissue contained 80–90% less GABA-T activity than control tissue. This loss of GABA-T was in agreement with values obtained in adjacent sections assayed in vitro. Similar studies in substantia nigra clearly and quantitatively demonstrated damage induced by ibotenate or kainate in this nucleus as well as in tissue in the overlying reticular formation. Moreover, two compartments of GABA-T were discriminated in substantia nigra: one associated with neural perikarya, which was sensitive to kainic and ibotenic acids (80% of total GABA-T), and a second associated with afferent terminals arising from forebrain projections (20%). Thus, after destruction of neurons with kainic or ibotenic acid, GABA-T activity is largely eliminated. Under these conditions, it appears that glia contribute relatively little to the GABA-T activity measured either histochemically or by direct chemical assay in homogenates.  相似文献   

14.
The effects of intrastriatal and intrahippocampal injections of the excitotoxic amino acid, quinolinic acid (QUIN), were examined in the rat using immunohistochemical and neurochemical techniques. Serotonin and 5-hydroxyindoleacetic acid measurements at 90 min, 6 h, 4 and 11 days following QUIN administration revealed highly elevated levels of the metabolite in the injected nuclei, with peak increases occurring after 4 days. Serotonin levels remained largely unchanged over the same time period. Direct visualization of hippocampal serotonergic fibers by immunohistochemistry demonstrated morphological changes (varicosities, swellings) in otherwise undamaged serotonin-positive afferents 4 days following a local QUIN injection. Hippocampal serotonin turnover was assessed at 4 days after an intrahippocampal QUIN-application: following inhibition of aromatic amino acid decarboxylase, the accumulation of 5-hydroxytryptophan was twice as rapid in QUIN-lesioned hippocampi as in controls. Dose-response relationships, examination of brain regions distant from the two injection sites and the temporal sequence of the changes described here suggest a close association between QUIN-induced neuronal degeneration and alterations in the serotonergic system.  相似文献   

15.
Unilateral lesions were induced in the substantia innominata (SI) of rats by 3 methods: electrocoagulation, 2 nmol kainic acid (KA) injection or 50–200 nmol folic acid (FA) injection. Histological examination by cresyl violet and GABA-transaminase staining and biochemical evaluation by glutamic acid decarboxylase (GAD) and choline acetyltransferase (ChAT) measurement were undertaken of the SI and several remote areas. Injections of FA into the SI produced much less local but more severe distant neuronal damage than did injections of KA. Both produced sustained epileptiform activity. Electrolytic lesions, on the other hand, produced only local neuronal damage and no epileptiform activity. Biochemical measurements of GAD and histochemical staining for GABA transaminase indicated many of the neurons in the distant areas affected following FA injections were GABAergic, but cholinergic neurons were relatively spared. Damage to the cortical areas was heaviest in the superficial layers. Dose-related losses were seen in GAD in a number of regions, with the most severe distant damage being in the amygdala and pyriform cortex and significant but lesser extent in the frontal, entorhinal and temporal cortices, and in the thalamus. The striatum and hippocampus were spared. The distant damage, except in the thalamus, seemed to parallel the density of cholinergic innervation from the SI as revealed by relative drops in ChAT following KA injections into the SI. Reduction in both seizure-like activity and remote damage was brought about by pretreatment of the animals with valium (20 mg/kg) or scopolamine (50 mg/kg). The protective action of scopolamine is consistent with the possibility that cholinergic neurons may mediate much of the remote damage to GABA neurons, although they themselves are little affected. Distant effects of injections of FA into the striatum were comparable in kind but much less in magnitude to those after SI injection while amygdala injections of FA did not produce significant losses in GAD in any of the regions examined.  相似文献   

16.
目的观察阿司匹林对沙土鼠全脑缺血-再灌注后的脑保护作用及其与脑内一氧化氮合酶及一氧化氮水平变化的关系。方法采用夹闭双侧颈总动脉的方法,制备沙土鼠短暂性全脑缺血-再灌注模型。27只健康雄性蒙古沙土鼠随机分为假手术组、脑缺血-再灌注组和阿司匹林治疗组,观察缺血7min再灌注24h后沙土鼠脑组织的病理学改变,以及一氧化氮合酶与一氧化氮水平的变化。结果病理学检查结果显示,沙土鼠脑缺血7min再灌注24h后海马CA1区缺血性损害明显,脑组织内一氧化氮合酶及一氧化氮水平显著升高(P<0.01);与脑缺血-再灌注组相比,阿司匹林治疗组沙土鼠的病理损害较轻,一氧化氮合酶与一氧化氮水平明显下降(P<0.01)。结论阿司匹林可显著减轻脑缺血-再灌注后的脑损伤,其作用机制可能与抑制一氧化氮合酶与一氧化氮水平上升有关。  相似文献   

17.
目的探讨血清透明质酸(HA)在急性自发性脑出血(ICH)发作后的变化及与ICH患者预后的关系。方法前瞻性收集284例自发性ICH患者为研究对象,记录一般资料、病史、临床资料以及影像学特点等指标;另外收集95例年龄和性别相匹配的健康人作为对照组进行对比分析。采用改良的Rankin量表对患者出院后90 d时情况进行评分,根据评分将患者分为预后良好组和预后不良组,对两组患者进行统计分析。结果 ICH患者血清HA水平高于对照组,差异具有统计学意义(P0.001)。284例患者中211例患者预后良好,73例患者预后不良;预后不良组患者HA水平(796.1±49.6 ng/mL),明显高于预后良好组的(487.2±42.9 ng/ml),两组比较差异具有统计学意义(P0.001)。患者HA水平与入院时的NIHSS评分呈正相关关系(r~2=0.372,P0.001);与治疗后90 d的mRS评分呈正相关关系(r~2=0.456,P0.001)。结论在急性自发性ICH患者中,HA表达水平明显升高,且入院时高血清HA水平是预后不良的预测因素。  相似文献   

18.
Intracerebral haemorrhage (ICH) is the most devastating type of stroke and is a leading cause of disability and mortality. By contrast with advances in ischaemic stroke treatment, few evidence-based targeted treatments exist for ICH. Management of ICH is largely supportive, with strategies aimed at the limitation of further brain injury and the prevention of associated complications, which add further detrimental effects to an already lethal disease and jeopardise clinical outcomes. Complications of ICH include haematoma expansion, perihaematomal oedema with increased intracranial pressure, intraventricular extension of haemorrhage with hydrocephalus, seizures, venous thrombotic events, hyperglycaemia, increased blood pressure, fever, and infections. In view of the restricted number of therapeutic options for patients with ICH, improved surveillance is needed for the prevention of these complications, or, when this is not possible, early detection and optimum management, which could be effective in the reduction of adverse effects early in the course of stroke and in the improvement of prognosis. Further studies are needed to enhance the evidence-based recommendations for the management of this important clinical problem.  相似文献   

19.
Spontaneous intracerebral hemorrhage   总被引:4,自引:0,他引:4  
To determine the prognostic value of etiology and localization in spontaneous intracerebral hemorrhage, 896 patients with spontaneous intracerebral hemorrhage, as proven by CT, operation or autopsy, were retrospectively studied using univariate data analysis. Etiologies were hypertension in 63.5%, cerebrovascular malformations in 8.5% and abnormal hemostasis in 15% of the patients. In 23% no etiology was determined. Main localizations were cerebral lobes in 49.2%, basal ganglia in 34.4%, brain stem in 6.9%, cerebellum in 6.7% and primary intraventricular in 2.3% of the patients. Ventricular extension was present in 47.0%. A higher case fatality correlated with: 1) ventricular extension ( P <0.00001), 2) increasing age ( P =0.00005), 3) surgical treatment ( P =0.00010), 4) localization in basal ganglia ( P =0.0108) and 5) hypertension as only etiology ( P =0.01471). A lower case fatality was found in patients with cerebrovascular malformations ( P =0.00006) and when the hemorrhage was localized to the cerebral lobes ( P =0.0050). We conclude that etiology and localization are of prognostic value in spontaneous intracerebral hemorrhage.  相似文献   

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