易卒中型自发性高血压大鼠（SHR—SP）基底动脉反应性的研究

应用细胞内微电极记录法 ,以血管平滑肌细胞膜电位为指标 ,研究了易卒中型自发性高血压大鼠基底动脉对有代表性的二类激动剂氯化钾 (KCl) ,去甲肾上腺素 (NE)及乙酰胆碱 (ACh)的反应性。观察到SHR- SP基底动脉平滑肌细胞膜电位 (Em)为 (- 45.7± 3.9) m V,明显低于 Wistar大鼠的 (- 55.1± 2 .0 )m V(P<0 .0 5) ,故其反应性增强。KCl(1 0～ 50 mmol/L)及 NE(1 0 -8～ 1 0 -6mol/L)引起膜电位的去极化 ,ACh(1 0 -7～ 1 0 -5mol/L)引起膜电位超极化 ,且皆呈剂量依赖性特征     

氯沙坦对卒中易感型自发性高血压大鼠的脑保护作用

目的 研究氯沙坦对卒中易感型自发性高血压大鼠(SHRsp)脑保护作用的机制。方法 6周龄雄性SHRsp随机分为生理盐水组、小剂量氯沙坦组(10mg·kg-1·d-1)和大剂量氯沙坦组(30mg·kg-1·d-1),记录血压和脑卒中临床表现评分,18周后处死,光镜观察脑卒中的发生率和脑血管结构;电镜观察脑组织的超微结构;TUNEL法检测神经细胞凋亡。结果 大剂量氯沙坦组血压明显低于未用药组(PO.05)。对照组SHRsp死亡率、脑动脉中膜厚度/管腔半径的比值和神经细胞凋亡率均高于小剂量和大剂量氯沙坦组,差异均有显著性意义(P相似文献   

易卒中型肾血管性高血压大鼠脑微血管超微结构观察

动态观察了易卒中型肾血管性高血压大鼠在高血压不同时期和卒中急性期的脑微血管病变。发现高血压早期已有脑微血管损害,并随血压升高和持续时间延长而加重,至高血压晚期出现管腔狭窄,内皮细胞水肿。此时虽未发生卒中,但受损微血管周围的神经细胞已出现线粒体肿胀,内质网扩张等缺血缺氧表现。卒中时,管壁结构严重破坏,有的管腔闭塞。显示高血压时脑微血管病变在高血压动脉硬化性卒中发病中起重要作用。     

芦荟大黄素对易卒中型肾血管性高血压大鼠大脑中动脉重塑的影响

目的观察芦荟大黄素对易卒中型肾血管性高血压大鼠（RHRSP）大脑中动脉结构改变的影响。方法取造模成功的36只RHRSP大鼠随机分成3组：芦荟大黄素低剂量治疗组、高剂量治疗组和高血压组，另取10只作为假手术对照组（除不上银夹外，其余措施同高血压模型组）。测量收缩压（SBP）和血浆中ET水平。血管平滑肌细胞经α-平滑肌肌动蛋白（α-SM-actin）免疫组化染色后，应用计算机图像分析测量大脑中动脉血管外径、中膜厚度、管腔内径、壁腔比和中膜平滑肌面积。结果低剂量治疗组血浆ET水平显著低于高血压组（P〈0．05），而高剂量治疗组则稍低（P〉0．05）。镜下观察发现低剂量治疗组血管形态损害比高血压组轻，而高剂量治疗组则无减轻甚至更重。低剂量治疗组血管外径、管腔内径、中膜厚度均大于高血压组（P〈0．05），壁腔比则小于高血压组（P〈0．05）。低剂量治疗组中膜平滑肌面积比高血压组大（P〉0．05），但在高剂量治疗组反而缩小（P〉0．05）。结论低剂量芦荟大黄素可降低RHRSP血浆ET水平，改善血管内皮功能，具有一定的改善血管重塑的作用。     

自由基清除剂联合巴曲酶治疗椎基底动脉系统进展型卒中

目的 评价新型自由基清除剂依达拉奉联合巴曲酶治疗椎基底动脉系统进展型卒中的有效性和安全性.方法 选择发病72h内的椎基底动脉系统进展型卒中患者76例,随机分为联合组和巴曲酶组,2组均采用巴曲酶注射液(10BU、5BU、5BU)静滴,隔日1次,共3次.联合组加用依达拉奉注射液30mg静滴,2次/d,共14d;巴曲酶组用等量生理盐水代替依达拉奉.2组病人分别在治疗前后定期进行神经功能缺损评分(NDS)并进行比较.结果 联合组临床显效率(63.16%)明显优于巴曲酶组(39.47%)(P＜0.01);2组均无明显不良反应.结论 依达拉奉联合巴曲酶治疗椎基底动脉系统进展型卒中安全有效.     

自发性高血压大鼠永久性脑缺血模型建立的研究

目的在比较自发性高血压大鼠(SHR)与同龄无高血压Wistar大鼠永久性大脑中动脉阻塞(pMCAO)后脑缺血损伤情况并初步分析其可能机制。方法雄性SHR和Wistar大鼠各30只分别随机分为:pMCAO模型6 h组、假手术6 h组、pMCAO模型24 h组、假手术24 h组和正常组(均n=6)。采用线栓法制作pMCAO模型,术后6、24 h对大鼠进行神经功能学评分后处死,制作脑冠状切片。术后6 h处死大鼠脑部切片行尼氏染色后在组织学层面上观察神经元损伤情况;术后24 h处死大鼠脑部切片行尼氏染色后计算脑梗死体积和水肿程度百分比。正常组脑部切片经苏木精-伊红染色后计算脑部小血管壁/腔比。结果术后6和24 h,不同品系大鼠神经功能学评分差异无统计学意义(P0.05);术后6 h尼氏染色示SHR神经元损伤重于Wistar大鼠。术后24 h SHR脑梗死体积百分比[(28.05±2.38)%]大于Wistar大鼠[(25.23±1.33)%],差异有统计学意义(P0.05)。两品系大鼠之间脑水肿程度差异无显著性。脑部小血管壁/腔比SHR[(11.46±3.74)%]较Wistar大鼠[(8.73±1.73)%]增大(P0.05)。结论 pMCAO术后SHR的脑缺血损伤程度重于Wistar大鼠,可能与高血压引起的脑侧支循环血管壁增厚、僵硬,自我调节能力降低有关。     

肝细胞生长因子对自发性高血压大鼠血压的影响

背景：肝细胞生长因子是一种多功能生长因子，它能促进多种细胞生长与移行及各种组织器官的发生。在心血管系统，它具有抗凋亡、抗纤维化、促进内皮细胞损伤后修复作用，推测其可能具有降压效应。 目的：观察外源性肝细胞生长因子对自发性高血压大鼠血压、血管内皮系统和肾素-血管紧张素系统的影响并探讨其调节血压的可能机制。 设计、时间及地点：随机对照动物实验，于2007-03/07在安徽医科大学第一附属医院心内科完成。 材料：外源性肝细胞生长因子粉剂购于美国Peprotech公司，成年自发性高血压大鼠组和WKY大鼠，均14周龄，体质量200~ 250 g。自发性高血压大鼠随机分为实验组和单纯自发性高血压大鼠组，WKY大鼠为正常对照组，每组12只。 方法：实验组每间隔24 h从尾静脉依次给予肝细胞生长因子5，10，15，20，25 μg/kg，自发性高血压大鼠组和正常对照组同时给予等量生理盐水。每次注射安抚大鼠5 min后测血压与心率，最后一次注射后观察血压降至最低值时(约注射后30 min)，麻醉后处死，各取右心室血2 mL。 主要观察指标：①观察肝细胞生长因子对自发性高血压大鼠组收缩压及心率的影响。②分别用比色法测血清一氧化氮水平、放射免疫法测血浆内皮素、血管紧张素Ⅱ水平。 结果：实验组注射肝细胞生长因子5 μg/kg血压下降不明显，注射10 μg/kg约5 min后血压开始下降，30 min降至最低，1 h后血压开始逐渐回升，5 h后血压基本回到原先水平。注射20 μg/kg达最大降压幅度，收缩压下降达40~50 mm Hg，再增加剂量最大降压幅度及持续时间不变。整过程心率无明显变化。两个对照组血压无明显变化。实验组较自发性高血压大鼠组内皮素、血管紧张素Ⅱ含量下降，一氧化氮含量上升（P < 0.05）。 结论：从静脉给予外源性肝细胞生长因子能快速降低自发性高血压大鼠组的血压，在一定剂量范围内，呈剂量-效应与时间-效应关系。肝细胞生长因子系统、血管内皮系统、肾素-血管紧张素系统可能共同参与血压的调节。     

基底动脉动脉瘤合并胚胎型大脑后动脉自发性闭塞的诊治分析(附1例报道并文献复习)

目的 总结基底动脉动脉瘤合并胚胎型大脑后动脉（FPCA）自发性闭塞致枕叶梗死的诊治经验,以提高此类疾病的认识,避免将FPCA残端误诊为动脉瘤。方法 回顾性分析1例基底动脉动脉瘤合并FPCA自发性闭塞致枕叶梗死的临床资料。结果 病人以突发右上肢麻木及视物模糊起病,外院DWI显示左侧枕叶内侧面梗死伴左侧丘脑灶样梗死,外院头颈部CTA示左侧颈内动脉后交通动脉动脉瘤（呈梭形）、基底动脉动脉瘤以及颅内多发血管硬化狭窄。我院左侧颈内动脉造影见左侧后交通动脉闭塞残端,残端远端可见中断后又部分显影,左侧大脑后动脉P1、P2均闭塞,椎动脉造影未见P1段发育,基底动脉中段动脉瘤。结合病人DWI梗死部位及术前灌注成像所示灌注失代偿区,考虑为左侧FPCA急性闭塞引起同侧枕叶梗死,CTA所谓的“梭样动脉瘤”其实为闭塞后的残端。采用双支架套叠辅助弹簧圈栓塞治疗基底动脉中段动脉瘤,出院时改良Rankin量表评分1分。结论 FPCA自发性闭塞临床极其罕见,急性闭塞后是否行血管内治疗依然存在争议;应加强对其影像学特征的认识和了解,以避免将其闭塞后残端误当做动脉瘤。     

大鼠基底动脉闭塞对脑干血流影响的实验研究

目的：观察大鼠基底动脉闭塞后对脑干血流变化的影响。方法：两点凝闭基底动脉，应用激光多普勒技术测量基底动脉闭塞前及闭塞后30、60、120分钟血流值。结果：基底动脉闭塞后脑干局部血流较闭塞前显著降低。结论：两点闭塞基底动脉效果可靠，激光多普勒可用来观察局部血流动力学变化。     

Solitaire~(TM)支架取栓治疗急性基底动脉闭塞研究

目的评估急性基底动脉闭塞患者使用SolitaireTM支架机械取栓的有效性和安全性,分析其临床预后的影响因素。方法回顾性分析本中心连续入组的30例急性基底动脉闭塞患者,均使用SolitaireTM支架设备进行机械取栓治疗分析支架,分析取栓治疗的再通率及并发症,评估治疗90 d临床预后,分析影响临床预后的因素。结果 30例患者均顺利完成机械取栓手术。患者平均年龄为(58.6±8.4)岁,术前美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分中位数25.5分(21.3,29.5),格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分中位数8分(6.0,9.8),改良Rankin量表(modified Rankin Scale,m RS)评分中位数5分(5.0,5.0)。成功再通[脑梗死溶栓分级(Thrombolysis in Cerebral Ischemia Scale,TICI)3或2b级]28例(93.3%),6例(20.0%)发生症状性颅内出血,9例(30.0%)患者预后良好(m RS 0~2分)。9例死亡,死亡率为30.0%(9/30)。术前患者意识不清(P=0.014)及m RS评分较高(P=0.020)与不良预后(m RS2分)相关。结论使用SolitaireTM支架进行急性基底动脉闭塞患者的机械取栓,有较高的再通率,能够改善功能性预后。     

Ischemia-reperfusion does not affect reactivity of isolated canine basilar artery

The effect of ischemia-reperfusion on endothelium-dependent relaxations and reactivity of vascular smooth-muscle cells was studied in rings of basilar arteries obtained from six dogs exposed to 12 min of complete global cerebral ischemia followed by 100 min of reperfusion. Three sham-operated control dogs served as controls. Ischemia was induced either by an increase in intracranial pressure or by aortic occlusion. The rings were suspended for isometric tension recording in physiological salt solution. Ischemia-reperfusion did not affect endothelium-dependent relaxations to vasopressin and bradykinin. In rings without endothelium relaxations to sodium nitroprusside, molsidomine (SIN-1), and papaverine as well as contractions to 5-hydroxytryptamine and KCl were preserved. These results demonstrate that in large canine cerebral arteries, ischemia-reperfusion of these durations does not affect relaxations mediated by activation of endothelium or direct relaxations and contractions of vascular smooth-muscle cells.     

Vascular reactivity in middle cerebral artery and basilar artery by transcranial Doppler in normals subjects during hypoxia

The anatomical and physiological differences between the carotid and vertebrobasilar circulations suggest the possibility of a different response to variations in systemic pO₂.We evaluated cerebrovascular response (CR) in these two systems by monitoring variations in the blood flow velocities in the middle cerebral and basilar arteries during hypoxia.Eighteen healthy, non-smoking volunteers underwent transcranial Doppler study during a state of hypoxia obtained by means of the rebreathing method. Oxyhaemoglobin saturation (SaO₂) was monitored using a pulsoxymeter in the 88–94% range. The cerebral blood flow velocity (BFV) was measured in the right middle cerebral artery (MCA) and the basilar artery (BA).Our findings indicate that the mean blood flow velocity (MFV) in the BA changes at a lower rate than that in the MCA during hypoxia.

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Sommario Le differenze anatomiche e funzionali tra la circolazione carotidea e vertebrobasilare suggeriscono la possibilità di una diversa risposta alle variazioni della PaO₂ sistemica.Abbiamo valutato la risposta cerebrovascolare in questi due sistemi monitorando le variazioni della velocità di flusso ematico nell'arteria cerebrale media e nell'arteria basilare durante ipossia. Diciotto volontari sani, non fumatori, sono stati sottoposti a studio Doppler Transcraniale durante ipossia ottenuta con il metodo del rebreathing. La saturazione della ossiemoglobina (SaO₂) è stata monitorata con un pulsossimetro (Minolta Pulsox 7) con un ambito di variazione da 88 a 94%. La velocità del flusso ematico cerebrale è stata misurata nell'arteria cerebrale media e nell'arteria basilare. I nostri risultati indicano che, durante l'ipossia, la velocità media del flusso ematico si modifica in misura minore nell'arteria basilare che nell'arteria cerebrale media.

     

基底动脉末段动脉瘤术中基底动脉的临时阻断

目的探讨基底动脉末段动脉瘤显微外科术中采用基底动脉临时阻断(TBAO)的可行性.方法回顾性分析892例基底动脉末段(基底动脉分叉部和基底动脉-小脑上动脉)非巨大动脉瘤显微外科术中采用TBAO与非TBAO的疗效并进行比较.结果单次阻断不超过5 min比较安全,超时或重复阻断则病残和死亡率增加;TBAO应慎重地用于术前不良分级、老年和多发性动脉瘤的患者,阻断的同期使用低血压(平均动脉压<70 mmHg)应视为禁忌.结论基底动脉动脉瘤早期外科治疗中采用TBAO较非TBAO疗效好.     

Acute basilar artery thrombosis

Acute basilar artery thrombosis (ABT) has been largely considered a neurological catastrophe. With conventional treatment, only around 20% of patients achieve functional independence. An early presumptive diagnosis is essential to avoid treatment delay. Either multiparametric magnetic resonance imaging or computed tomography angiography source images may represent valid non-invasive tools to confirm ABT and evaluate ischemic tissue viability. The main determinant of ABT outcome is early recanalization but the most effective therapeutic option remains to be clarified. The BASICS prospective registry showed no superiority of intra-arterial over intravenous thrombolysis. Therefore, in the absence of contraindications, intravenous thrombolysis should be started as soon as possible and can be used as the main therapy when interventional procedures are not available. However, recent case series have reported high rates of functional independence (50%) after staged escalation therapy (ultra-early intravenous thrombolysis followed by on-demand endovascular mechanical thrombectomy). These results represent a hope for patients and neurologists and reinforce the need for innovation and research in this field.