兔蛛网膜下腔出血后迟发性脑血管痉挛程度的分级标准判 定

目的 探讨兔迟发性脑血管痉挛模型制作方法及脑血管痉挛程度的分级标准。方法 应用两次枕大池注血法建立兔迟发型脑血管痉挛模型，分别在造模后1,3,7 d观察动物模型的行为学后，行DSA造影；然后取基底动脉进行HE染色和扫描,透射电镜观察。结果 造模后3,7 d，出现明显行为和神经功能异常，血管造影显基底动脉中度-重度痉挛；HE染色示基底动脉血管管壁增厚，管腔变小，血管明显痉挛；透射电镜观察显示，造模后3 d基底动脉内皮细胞核出现凋亡小体，线粒体空泡样变性，造模7 d基底动脉内皮线粒体肿胀溶解，包浆空泡样变性。结论 应用两次枕大池注血法能够重复建立成功的兔迟发型脑血管痉挛模型，在此基础上可以制定脑血管痉挛程度的判定标准（4级分法），有利于科学地综合评价迟发型脑血管痉挛模型。

Establishment of delayed cerebral vasospasm model and judgment standards for the degree of vascular cerebral vasospasm in rabbits

Objective To establish a stable delayed cerebral vasospasm (DCVS) model in rabbits and to explore a standard of DCVS grading. Methods DCVS model was established by method of double-injection of autogenous blood into cisterna magna in 50 rabbits, of whom, 16, 16 and 18 were sacrificed respectively 1, 3 and 7 days after establishing model. Of 30 rabbits serving as control group, 10, 10 and 10 were sacrificed respectively 1, 3 and 7 after the second injection of 0.9% saline into cisterna magna. The changes in behavior were determined by Baker et. al. method and then DSA were performed before the sacrificing in all the rabbits. The changes in pathology and ultrastructure of the basilar arteries were observed respectively by light microscope and electron microscope. Results The scores of Baker et al. behavior were significant higher in the model group than those in the control group 7 days after establishing model (P<0.05). DSA showed that the basilar arteries had medial and severe spasm in the model group respectively 3 and 7 days after establishing model compared with that in the control group (P<0.05). The pathological examination showed that the significant increase in thickness of the basilar artery wall and significant decrease in the lumen diameter of the basilar artery in the model group 3 and 7 days after the second injection compared to those in the control group (P<0.05). The electron microscope examination showed that apoptotic bodies emerged in the nuclei of endothelial cells of the basilar artery and their mitochondria vacuolar degeneration appeared 3 days after establishing model and mitochondria of endothelial cell of basilar artery swelled irregularly and their cristae fractured and became fuzzy and cytoplasmic vacuoles degeneration appeared 7 days after establishing in the model group. Conclusions A stable DCVS model can be successfully and repeatedly established by the method of cisterna magna double-injection of autogenous blood in rabbits. The present results suggest that DCVS severity may be judged by grades 1~4 standards.