颅内动脉瘤手术中暂时阻断载瘤动脉的动物实验研究

目的探讨采用不同的颅内动脉瘤载瘤动脉阻断方法对神经功能的影响。方法82只蒙古沙土鼠,雌雄各半,随机分为正常对照组(10只)、假手术组(8只)和缺血-再灌注损伤组(实验组)。根据术中动脉阻断时间及再灌注时间的不同,实验组动物再分为8个亚组,每组8只,共64只。手术后收集脑组织间液,应用微透析仪分析其中葡萄糖、乳酸、丙酮酸、甘油水平以及乳酸/丙酮酸比值的变化,并依照Longa等的5分评分方法评定沙土鼠神经功能损伤程度,以观察缺血-再灌注损伤对脑组织间液中生化物质水平,以及各种不同阻断方式对神经功能的影响。结果实验组沙土鼠组织间液中的葡萄糖、乳酸、甘油水平及乳酸/丙酮酸比值的变化与对照组相比,差异有显著性意义(P<0.01);实验组各亚组间比较,葡萄糖、乳酸、甘油水平及乳酸/丙酮酸比值的变化差异亦有显著性意义(P<0.01);而丙酮酸水平的变化差异无显著性意义(P>0.05)。手术后72h,对各组沙土鼠的自主活动能力进行评价显示,假手术组、实验组第8、4亚组鼠神经功能受损较轻,实验组第1、2、3亚组受损较重。结论在灌注时间充足时,分次阻断载瘤动脉比一次长时间阻断对神经功能的损伤轻;在灌注时间不足时,分次阻断载瘤动脉所导致的神经功能损伤程度与一次长时间阻断相比无明显差异。故而在动脉瘤切除手术

Study on temporary arterial occlusion in intracranial aneurysm operation

Objective To study the effect of different approaches fo r occlusion the aneurysm affected arteries on neurofunction.Methods Eighty-tw o gerbils(41male and41female)were randomly divided into control group(n =10),false-operation group(n=8)and experiment (ischemia-reperfusion injury)group(n=64),and the last group were divided into8subgroups each o f8gerbils according to different duration of arterial occlusion and reperfusio n.Cerebral interstitial fluid was collected after operation,and the changes of glucose,lactic acid,pyruvic acid,glycerol levels and the ratio of lactic aci d/pyruvic acid were analyzed by microdialy-sis.The injured degree of neurofun ction was evaluated by Longa scale for study the influence of ischemia-reperfus ion injury on the biochemical parameters in cerebral interstitial fluid and the effect of different arterial occlusion methods on neurofunction.Re sults The l evel changes of glucose,lactic acid,glycerol and the ra-tio of lactic acid/p yruvic acid in the experiment group were significantly different from that in the controls(P<0.01),and the difference between subgroups was also signi ficant (P<0.01),but the level change of pyruvic acid was not significan tly different (P>0.05).The autonomous activity of different group gerbi ls estimated in72h postoperatively demonstrated that the injury was mild in fa lse-operation group and the8th and4th sub-group,and the injury was severe i n the1st,2nd and3rd subgroup.Con clusion Assisting with sufficient reperfu sion,the interrupted repeated arterial occlusion may cause milder injury of neu rofunction than one time prolonged arterial occlusion.Under unsufficient dura tion of reperfusion,there is no significant difference be-tween the injury in tensity of neurofunction resulted in interrupted repeated arterial occlusion and one time prolonged occlusion for aneurysm affected arteries.Thus in aneurysm resection the time of first interrupted arterial occlusion should not be too lo ng and assist with sufficient reperfusion after occlusion is necessary in reduc ing cerebral ischemia.