亚低温对完全性脑缺血再灌注后丙二醛含量和超氧化物歧化酶活性的影响

目的：观察完全性脑缺血再灌注后全脑亚低温对脑组织丙二醛（ＭＤＡ）含量和超氧化物歧化酶（ＳＯＤ）活性的影响．方法：将１７只犬随机分为三组：非缺血对照组、缺血对照组和亚低温治疗组，采用谭秀娟等建立的心脏停跳复苏动物模型，于心肺复苏后４小时取脑组织测定ＭＤＡ含量和ＳＯＤ活性．结果：全脑缺血１０分钟后再灌流４小时，脑组织ＭＤＡ含量明显上升（Ｐ＜０．０１），ＳＯＤ活性下降（Ｐ＜０．０１）；而３４℃亚低温治疗组与缺血对照组比较，ＭＤＡ含量明显下降（Ｐ＜０．０１），ＳＯＤ活性上升（Ｐ＜０．０１）．结论：完全性脑缺血再灌注后全脑亚低温可抑制脑内脂质过氧化反应，保护脑组织自身抗氧化能力，有利于脑复苏．     

亚低温对完全性脑缺血再灌注后丙二醛含量和超氧化物歧化酶活性…

目的；观察完全性脑缺血再灌注后全及亚低温对脑组织丙二醛（ＭＤＡ）含理和超氧化物歧估酶（ＳＯＤ）活性的影响。方法；将１７只犬随机分为三组；非缺血对照组，缺血对照组和亚低温治疗组，采用谭秀娟等建立的心脏停跳 苏动物模型，于心肺后４小时取 组织测定ＭＤＡ含量和ＳＯＤ活性。结果；全脑缺血１０分钟后再灌流４小时，脑组织ＭＤＡ一明显上升（Ｐ〈０．０１），ＳＯＤ活性下降（Ｐ〈０．０１）；再３４℃亚低温治疗组与缺     

外源性重组白细胞介素1受体拮抗剂对大鼠脑创伤的治疗作用

目的观察外源性重组ＩＬ－１受体拮抗剂（ＩＬ－１ｒａ）对实验性脑创伤的治疗作用，以及对脑组织中ＮＴＦα、ＩＬ－６两种炎性细胞因子水平的影响。方法采用液压型脑创伤装置造成大鼠右顶部脑挫伤。治疗组动物分别于脑创伤后１５分钟，２，４，６，８，２４，４８小时左侧侧脑室内注射１０μｇ的ＩＬ－１ｒａ，总剂量为每只７０μｇ。动物于创伤后３天处死，脑组织连续切片染色，计算出创伤体积，通过比较动物创伤灶体积大小观察ＩＬ－１ｒａ的疗效。结果ＩＬ－１ｒａ治疗组创伤体积为（２１．６±５．９）ｍｍ３，对照组为（２９．４±５．７）ｍｍ３，ＩＬ－１ｒａ治疗组脑创伤灶体积明显小于对照组（Ｐ＜０．０５）。另外，创伤后８小时观察，ＩＬ－１ｒａ治疗组创伤侧皮层ＩＬ－６的水平为（２４３．１±３７．８）Ｕ／ｍｇ，对照组为（２９８．８±４９．２）Ｕ／ｍｇ，ＩＬ－１ｒａ治疗组动物脑组织内ＩＬ－６的水平低于对照组（Ｐ＜０．０５）。结论脑室内注射外源性ＩＬ－１ｒａ可有效减轻大鼠脑创伤的损伤程度和范围，ＩＬ－１ｒａ除能拮抗ＩＬ－１的直接作用外，可能还通过影响其他炎性因子（如ＩＬ－６）的生成间接抑制炎性反应，从而对缓解脑创伤后继发炎性损害有十分重要的作用     

大鼠脑缺血时血与脑中一氧化氮、超氧化物歧化酶和丙二醛含量的变化

目的探讨一氧化氮（ＮＯ）、超氧化物歧化酶（ＳＯＤ）和丙二醛（ＭＤＡ）在急性脑缺血时血与脑中的含量变化及其作用。方法４６只Ｗｉｓｔａｒ大鼠分为假手术组和缺血组。假手术组颈部正中切口，分离两侧颈总动脉；缺血组，结扎大鼠双侧颈总动脉，对缺血不同时相血清、脑皮层和丘脑组织中的ＮＯ、ＳＯＤ和ＭＤＡ含量进行测定。结果大鼠脑缺血１０分钟血清、脑组织ＮＯ浓度增高，３０分钟血清和脑组织中ＮＯ浓度最高，于６０分钟血清和脑组织中ＮＯ浓度下降至脑缺血１０分钟时的水平；而缺血１８０分钟血清和脑组织中ＮＯ浓度最低，并于３６０分钟后血清和脑组织中ＮＯ浓度回升，且较对照组升高但无显著性差异（Ｐ＞０．０５）。脑缺血１０，３０与６０分钟大鼠血清、脑组织中ＮＯ显著高于对照组（Ｐ＜０．０１和Ｐ＜０．００１）。脑缺血３０，６０，１８０与３６０分钟，大鼠ＳＯＤ活力显著低于对照组（Ｐ＜０．０５，Ｐ＜０．０１和Ｐ＜０．００１）；而ＭＤＡ显著高于对照组（Ｐ＜０．０５，Ｐ＜０．０１和Ｐ＜０．００１）。结论脑缺血时间越长ＳＯＤ酶活力越低而ＭＤＡ含量越高，长时间将大量产生释放具有神经毒性及细胞毒性作用的ＮＯ，可引起神经元死亡及细胞和组织损伤。     

增强MRI评价可逆性血脑屏障开放的可靠性及价值

目的评价增强ＭＲＩ在监测可逆性血脑屏障（ＢＢＢ）开放的可靠性及价值。方法３６只家兔被随机分为３组：Ａ、Ｂ两组分别经颈内动脉灌注２０％甘露醇和生理盐水，Ｃ组经耳缘静脉灌注２０％甘露醇。灌注后，立即用０．５Ｔ超导型ＭＲ机进行兔脑冠状位扫描，随后经耳缘静脉注入ＧｄＤＴＰＡ，迅速行同层间隙扫描（增强后５、１０、１５、２０分钟，之后每隔１０分钟），持续２小时。以该层双侧对称的脑实质为兴趣区，测得不同时间兴趣区信号强度（ＳＩ），求其增强率（％）。各组１０只兔于扫描前经耳缘静脉注入２％Ｅｖｅｎｓ蓝（２ｍｌ／ｋｇ），２小时后处死；另有６只分别于灌注后２．５、３小时注入Ｅｖｅｎｓ蓝，１０分钟后处死，取脑观察有无脑实质蓝染，以此来推测ＢＢＢ开放持续时间。所有脑标本送病理检查，并与对应层的ＭＲＩ进行比较。结果Ａ组１０只皆出现灌注侧脑实质增强及蓝染，Ｂ、Ｃ组无一只出现明显强化及蓝染。ＢＢＢ开放持续时间小于３小时。未发现死亡及脑实质病理改变。结论增强ＭＲＩ是监测ＢＢＢ开放过程、指导临床个体化用药的一种理想方法。     

大鼠运动至力竭过程中β-内啡肽样免疫反应物质的变化

Ｗｉｓｔａｒ大鼠１５只，２月龄，雌雄各异，体重１３２－１５４ｇ，自由饮食，室温１８－２５℃。实验前１周大鼠经适应性游泳３次，每次１０分钟，然后随机等分成３组：第１组为对照组；第２组为游泳６０分钟组；第３组为游泳至力竭组。第２、３组大鼠置游泳缸（水温３０±２℃）内游泳，每只鼠加３％体重尾负荷。第２组大鼠游泳至６０分钟取材，第３组游至力竭后取材。平均力竭时间３．２±０．４ｈ。所有动物直接断头处死，收集躯干血３ｍｌ，加人含６０ｕｌ０．３ｍｏｌ／Ｌ的ＥＤＴＡ。Ｎａ２（０．１ｍｏｌ／Ｌ的磷酸缓冲盐液，ｐＨ…     

不同深低温停循环方法对脑组织ATP酶的影响

目的：观察深低温停循环对脑组织ATP酶活力及结构的影响。方法：18只实验犬随机分为3组，深低温停循环（DHCA）组，DHCA＋逆行脑灌注（RCP）组，DHCA＋顺行间断脑灌注（IACP）组。降温至18℃后停循环90min，在停循环前、后及再循环后留取血液标本作ATP酶活力和乳酸含量测定。手术结束时取海马组织作透射电镜检查。结果：停循环后，DHCA和RCP组ATP酶活力值显著降低，乳酸含量显著升高；IACP组ATP酶活力值无显著差异，乳酸含量仅在停循环后45min时显著升高。结论：DHCA时间较长时，脑组织会发生缺血缺氧性损伤；RCP对脑组织有保护作用，但易发生神经细胞水肿；IACP的脑保护效果较为理想。     

可取出式动脉滤器在颈动脉血管成形术中脑保护效率的动物实验研究

目的制作犬颈内动脉的选择性灌注模型,验证可取出式动脉滤器对犬脑的保护效率.方法健康杂种犬12只,随机分为滤器组及对照组.以明胶海绵栓塞颈外动脉,制作犬颈内动脉的选择性灌注模型.滤器组每只犬于颈总动脉内滤器近侧注入1m×1mm×1mm大小的血栓5个,对照组犬则不用滤器,直接注入栓子.术后观察动物神经系统功能改变情况,术后24h行犬脑MR检查,术后7d将犬脑取出、固定,行大体病理检查.结果栓子注入后血管造影,对照组犬中,5只显示颈内动脉分支闭塞,滤器组犬均未见颈内动脉栓塞表现.对照组犬中,5只术中出现对侧肢体及颈部强直,其中2只在注入栓子后于术中死亡;滤器组犬中,2只术后出现栓塞对侧肢体轻瘫,12～24h后症状消失.对照组犬中,4只术后MR显示栓塞侧大面积脑梗死;滤器组犬中,除1只犬术后MR显示术侧外囊点状梗死灶外,其余5只犬术后MR显示正常.术后大体病理表现与MR结果相符.结论动脉滤器对约1mm大小的较大栓子有令人满意的捕获能力,能有效防止严重脑梗死并发症的发生.但此种动脉滤器对小于1mm的栓子的捕获能力尚待进一步研究.     

选择性脑亚低温治疗重型颅脑损伤

目的　比较选择性脑亚低温与全身亚低温治疗重型颅脑损伤的治疗效果。方法　将 6 9例重型颅脑损伤 (GCS≤ 8分 )患者分成 3组 :(1 )选择性脑亚低温组 2 3例 ,头部局部降温 ,将脑温降至 33～ 35℃ ,治疗 3～ 5日 ;(2 )全身亚低温组 2 2例 ,全身降温 ,将脑温降至 33～ 35℃ ,治疗 3～ 5日 ;(3)常温对照组 2 4例 ,予常规治疗。结果　选择性脑亚低温组预后良好率为 5 6 .5 % (1 3/ 2 3) ,病死率 2 1 .7% (5 / 2 3) ,与全身亚低温组相仿 [分别为 5 4 .5 % (1 2 / 2 2 )和 2 2 .7% (5 / 2 2 ) ],与对照组比较 (良好率 2 5 % ,病死率 4 5 .8% ) ,有显著差异(P <0 .0 5 )。全身组与对照组总并发症发生率比较无显著差异 (P >0 .0 5 ) ,而选择性脑亚低温组总并发症发生率明显低于全身组与对照组 (P <0 .0 1 )。结论　选择性脑亚低温对重型颅脑损伤的疗效与全身亚低温相仿 ,明显优于常温对照组 ,是目前治疗重型颅脑损伤安全而有效的方法之一。     

创伤性脑损伤后脑温与局部脑血流量变化关系的实验研究

目的：通过制作创伤性脑损伤动物模型，研究不同程度脑损伤后脑温及局部脑血流量（ｒＣＢＦ）变化的关系。方法：猫３３只，随机分成三组：中度脑损伤组、重度脑损伤组和对照组；采用铜－康铜热电偶测定脑温，氢清除法测定ｒＣＢＦ。结果：脑损伤后早期ｒＣＢＦ即明显减少（Ｐ＜０．０５），伤后６小时内下降最为明显，损伤越重，ｒＣＢＦ下降越多，皮层ｒＣＢＦ下降幅度大于白质；伤后脑温也呈逐渐下降趋势，损伤越重，脑温下降越明显，皮层温度下降程度大于白质，伤后２４小时，中度损伤组皮层温度平均下降２．１℃，白质下降１．７℃，重度损伤组皮层温度平均下降３．３℃，白质下降２．６℃。脑温与ｒＣＢＦ呈一致性变化，二者间有良好的相关性（Ｐ＜０．０１）。结论：脑损伤后脑温呈下降趋势，脑温的变化在一定范围内能较好地反映ｒＣＢＦ的变化，对临床具有实际意义     

A simplified arteriovenous malformation model in sheep: feasibility study.

BACKGROUND AND PURPOSE: Recently, a swine model of a cerebral arteriovenous malformation (AVM) has been developed that closely resembles a human AVM of the brain. The creation of such a model requires sophisticated neurointerventional techniques. The purpose of this study was to develop a simple and cost-effective AVM animal model that does not require additional endovascular techniques. METHODS: A surgical anastomosis was created in seven sheep between the common carotid artery and the ipsilateral jugular vein, followed by ligation of the jugular vein above the anastomosis and of the proximal common carotid artery below the anastomosis. The anastomosis was created on the left side in four animals and on the right side in three. Cerebral angiography from the contralateral carotid artery was performed before and immediately after surgery to delineate the relevant cerebral vascular anatomy and to determine the direction of blood flow. RESULTS: An angiographic appearance simulating an AVM was found in all the animals. The ramus anastomoticus and arteria anastomotica functioned as the feeding vessels to the rete mirabile, which represented the nidus in our model, and to the jugular vein, which represented the draining vein from the malformation. Extensive collateral flow through the rete mirabile into the distal segment of the external carotid artery above the ligature was observed angiographically, with retrograde flow through the surgical anastomosis into the jugular vein. CONCLUSION: A simple surgically created experimental model for cerebral AVMs was developed in sheep without the need for additional complex endovascular catheter manipulations of intracranial branches. Such an animal model can substantially reduce the cost of research and training in the neurointerventional or radiosurgical management of AVMs.     

局部亚低温对大鼠脑缺血组织钙调神经磷酸酶活性的影响

为探讨局部亚低温的脑保护作用，制备大鼠大脑中动脉脑缺血模型。分为常温组、FK－506组、亚低温组和正常对照组，测定缺血后不同时间脑组织中钙调神经磷酸酶（CaN）的活性。结果发现，常温组、FK－506组于缺血后6h CaN活性开始下降，而亚低温组CaN活性无明显变化，差异有显著意义。说明局部亚低温治疗可明显抑制缺血脑组织中CaN活性的变化，具有明确的脑保护作用。     

Cerebral Hyperperfusion Syndrome after Endovascular Reconstruction of Carotid Artery in High-Flow Carotid-Jugular Fistula

We describe the occurrence of cerebral hyperperfusion syndrome (CHS) in a case of long-standing carotid-jugular fistula (CJF) treated by endovascular reconstruction of the carotid artery. A 43-year-old male with a high-flow CJF between the internal carotid artery (ICA) and internal jugular vein underwent endovascular reconstruction of the carotid artery using a stent graft. After treatment, the patient developed CHS. The patient succumbed to a large intracranial bleed in the left external capsule and parietal lobe on the fifth postoperative day. CHS following endovascular reconstruction of carotid artery is rare. We present the first reported case of CHS following endovascular reconstruction of ICA. A review of literature for patients treated by endovascular rerouting of blood flow to the cerebral parenchyma associated with hyperperfusion syndrome has been performed.     

An adult case of congenital external carotid-jugular arteriovenous fistula with reversible circulatory insufficiency in the cerebellum and lower brain stem

A 27-year-old man with congenital external carotid-jugular arteriovenous fistula presented with a diminished level of consciousness and an ataxic gait. Axial fluid-attenuated inversion-recovery (FLAIR) MR imaging revealed venous congestion, a dilated right jugular vein, and an area of high signal intensity in the brain stem and cerebellum. Angiography showed a dilated right external carotid artery and jugular vein and the presence of a fistula. After coil embolization of the fistula, axial MR FLAIR images showed only a few areas of high signal intensity in the brain stem and cerebellum. The causal factor was venous congestion in the inferior petrosal sinus and basilar plexus due to high blood pressure in the jugular vein. This case is presented for its unusual clinical and radiologic findings.     

高原人工肝支持系统体外血液循环的建立

目的 在高原环境下建立适用于人工肝支持系统治疗研究的大动物体外血液循环方法.方法 已适应本地环境(海拔3700m)的健康长白仔猪6只,在盐酸氯胺酮及地西泮静脉注射麻醉下,分别行颈总动脉/颈外静脉插管及经左颈外静脉至下腔静脉/右颈外静脉插管,分为相应的两组(n=3),1d后连接血路及反应器装置,采用转流速度阶梯升高的方式...     

经右腋动脉选择性脑灌注在主动脉夹层手术中的应用

目的总结右腋动脉插管体外循环(ECC)、选择性顺行脑灌注在主动脉夹层手术中应用的初步经验。方法回顾性分析我院2005年1月—2008年7月采用深低温停循环(DHCA)加右腋动脉插管选择性顺行脑灌注(ASCP)手术治疗I型主动脉夹层10例。男8例,女2例。年龄24~63岁,平均(41.7±12.0)岁。升主动脉+全弓置换+降主动脉术中支架置入术5例,升主动脉+全弓置换2例,升主动脉+右半弓置换3例。结果本组主动脉阻断时间83~258min,平均(132.3±52.8)min。深低温停循环时间8~53min,平均(29.10±18.30)min,选择性脑灌注时间8~58min,平均(33.4±18.5)min。手术死亡2例,1例因术中出血、体外循环时间长不能脱机,1例因术后低心排和多脏器功能衰竭。术后暂时性脑损害2例,均治愈出院,无永久性脑损害发生。结论右腋动脉插管灌注和顺行脑灌注在主动脉夹层手术中可提供有效的脑保护,其操作简便、安全。     

Usefulness of selective cerebral angiography by transradial approach

Transradial angiography has recently emerged as an alternative to the transfemoral or transbrachial approach, especially for coronary procedures. However, there have been few studies on cerebral angiography using the transradial approach. The purpose of this study was to assess the outcomes, complications, and limitations of selective cerebral angiography via the transradial approach. Selective cerebral angiography by the right transradial approach using 100-cm-long 4-F catheters was performed in 83 patients. Using five types of catheters, the success rates of selective catheterization to the right vertebral artery, right common carotid artery, left common carotid artery, and left vertebral artery were 40/44 (91%), 68/68 (100%), 62/62 (100%), and 14/25 (56%), respectively. Puncture failed in one patient, and a guidewire could not be introduced beyond the radial artery loop in one patient. Radial artery spasm occurred in one patient, but was relieved immediately after nitroglycerin injection through the sheath with side holes. Subcutaneous bleeding occurred in six patients, but no obvious hematomas were noted. Occlusion or stenosis of the radial artery occurred in five patients, but no ischemic symptoms were observed in any of the cases. This study suggested that selective cerebral angiography can be performed safely using the transradial approach.     

亚低温疗法在重型颅脑损伤治疗中的作用

目的探讨亚低温冬眠疗法对重型颅脑损伤患者的脑保护机制及临床疗效。方法将65例重型颅脑损伤患者(格拉斯哥昏迷评分≤8分)随机分为亚低温组(33例)和常温组(32例)。亚低温组入院后1~5 h内行亚低温冬眠治疗,输液泵持续静脉点滴冬眠合剂,肛温控制在32~35℃,亚低温冬眠治疗3~7 d,同时检测颈动脉和颈静脉血气、电解质、生命体征等指标。常温组除未行亚低温冬眠治疗外,其余治疗及监测方法同亚低温组。两组患者均于伤后根据格拉斯哥预后评分(GOS)判定疗效。结果亚低温组比常温组脑氧耗及死残率明显降低,预后明显改善。结论亚低温冬眠疗法具有显著的脑保护作用,临床应用于重型颅脑损伤救治安全有效,无严重并发症。     

Iodine-123 IMP SPECT before and after bypass surgery in a patient with occlusion of left anterior and middle cerebral arteries with basal abnormal telangiectasis (unilateral Moyamoya disease)

A case of left anterior and middle cerebral arterial occlusion with angiographic features similar to Moyamoya disease was reported. IMP SPECT of the patient revealed the success of bypass surgery clearly. The patient complained of transient right hemiparesis with aphasia 4 times. The cerebral arteriography disclosed occlusions of left anterior and middle cerebral arteries at their proximal portions. Right internal carotid and its branches were normal. I-123 IMP SPECT study showed hypoperfusion in left temporal lobe, basal ganglia with incomplete reperfusion on the delayed (4 hours after injection) SPECT images. After the superficial temporal-middle cerebral artery anastomosis, I-123 IMP SPECT showed improvement of the brain blood flow. I-123 IMP SPECT was very useful in detecting the ischemic areas and evaluating the revascularizing surgery in this case.     

Symptomatic cavernous sinus aneurysms: management and outcome after carotid occlusion and selective cerebral revascularization

BACKGROUND AND PURPOSE: Therapeutic internal carotid artery (ICA) occlusion for symptomatic intracavernous artery aneurysms can result in ischemic infarction despite normal clinical balloon test occlusion (BTO). We evaluated outcomes in patients with symptomatic cavernous sinus aneurysms in whom clinical BTO was normal, who underwent carotid occlusion with selective bypass surgery guided by physiologic BTO using quantitative cerebral blood flow (CBF) analysis by means of stable xenon-enhanced CT. METHODS: After a normal clinical BTO, 26 consecutive patients with symptomatic cavernous sinus aneurysms underwent a baseline xenon-enhanced CT CBF analysis followed by a second CBF analysis, during which repeat BTO was performed. Patients with a decrease in cortical CBF to below 30 mL/100 g/min were considered moderate risk and those with greater than 30 mL/100 g/min were low risk for developing postocclusion ischemic infarction. Moderate-risk patients underwent cerebral revascularization followed by proximal carotid occlusion. Low-risk patients underwent carotid occlusion alone. Patients were clinically followed up for at least 3 months after carotid occlusion. All patients underwent head CT at least 1 month after carotid occlusion. RESULTS: Eight patients were moderate risk and 18 low risk. Mean follow-up was 15.3 months. Mean CT follow-up was 10.2 months. No low-risk patient developed a postocclusion ischemic deficit by examination or infarct by CT. One patient in the moderate-risk group developed right hemiparesis and a left posterior middle cerebral artery infarction by CT 2 months after carotid occlusion. CONCLUSION: In this series, BTO combined with quantitative CBF analysis was a safe and reliable technique for identification of patients at risk for ischemic infarction after carotid occlusion, despite a normal clinical BTO.