亚低温治疗急性脑梗死的复温方式比较

目的比较亚低温治疗急性脑梗死时3种不同复温方式的效果.方法30只大鼠随机分为自然复温组(对照组)、主动体外复温组(光照法)和主动体内复温组(灌胃法).采用改良线栓法制备大鼠大脑中动脉供血区缺血(MCAO)模型,6 h后诱导亚低温,24 h后开始复温,监测颅内压、血压、心率、肛温,复温过程结束后比较脑梗死体积、神经功能评分以及死亡率.结果复温4 h后灌胃组肛温明显低于光照组,血压开始显著上升(P＜0.05),6 h后血压明显高于光照组(P＜0.05);3组在复温过程中颅内压都明显高于复温前(P＜0.01),光照组复温后4h颅内压低于对照组(P＜0.05),灌胃组6 h后颅内压高于对照组(P＜0.05);3组在复温过程中心率变化没有差异(P＞0.05);复温结束后灌胃组血压、颅内压、神经功能评分、梗塞灶体积明显高于光照组(P＜0.05),死亡率高于对照组和光照组(P＜0.05).结论在亚低温治疗急性脑梗死的复温方法中,灌胃法主动复温不可取,光照法主动体外复温效果较好.

Differential effects of three rewarming methods of hypothermia in cerebral ischemia in rats

Objective To evaluate the differential effects of three rewarming methods of hypothermia in cerebral ischemia in rats. Methods Thirty Wistar rats were randomly assigned to three groups as follows: passive rewarming group (control, PR), active surface rewarming group (shining, SR) and active internal rewarming group (douche, IR). We used the intraluminal filament occlusion model in rats to cause focal cerebral ischemia for 6 h,then all the rats were introduced into hypothermia for 24 h before rewarming. Intercerebral pressure (ICP), blood pressure (BP), heart beating (Hb), rectal temperature (RT) were assessed and compared. Infarction size of brain (IS), neurologic deficits(ND) and mortality were compared after rewarming. Results The 4 th hour after rewarming, RT in IR was obviously lower than SR( P < 0.05 ), at the same time, BP in IR obviously increased( P < 0.05 ). The 6th hour after rewarming, BP in IR was obviously higher than SR( P < 0.05 ). ICP in all the three groups increased obviously. The 4th hour after rewarming, ICP in SR was obviously lower than PR,which in IR was obviouely higher than PR from the 6th hour after rewarming. At the end of rewarming, the time cost to reach target temperature, IS, ND,ICP and BP in IR were obviously higher than SR( P < 0.05 ). Mortality in IR was obviouely higher than other two groups( P < 0.05 ). Conclusions Douche was not an advisable methods to commend. Shining was the appropriate one.