创伤性颅脑损伤后细胞凋亡状态与脑水肿、颅内压的相关性研究

目的探讨创伤性颅脑损伤后细胞凋亡与脑水肿及颅内压变化的相关性及其临床意义.方法采用改进的Fenney法自由落体损伤模型,将42只重型颅脑损伤的家兔分为两组,用TUNEL法计算凋亡神经细胞数,计算不同时期的脑组织含水量及检测颅内压的动态变化,并将细胞凋亡状态与脑水肿、颅内压进行相关性分析.结果损伤组家兔脑组织凋亡细胞数及颅内压水平在创伤后3d时达到一个较高水平(P＜0.01),而脑组织含水量在1d时已经达到峰值(P＜0.01);通过相关性分析,在颅脑创伤的不同时期,细胞凋亡状态与脑组织含水量及颅内压之间存在正相关性(P＜0.05 or 0.01);在总体(n=36)相关性比较以及回归分析中发现,凋亡细胞数与脑组织含水量、颅内压存在相关性.结论创伤性颅脑损伤后,随着脑水肿的加重,颅内压的进一步升高,细胞凋亡数也相应增加.减轻脑水肿、降低颅内压,可以减少颅脑损伤后的神经细胞凋亡,从而达到减轻继发性脑损害的作用.

The Association of Cell Apoptosis with Cerebral Edema and Intracranial pressure after Traumatic Craniocerebral Injury

Objective To explore the association of cell apoptosis with cerebral edema and intracranial pressure after traumatic brain injury and its clinical significance. Methods The injury model was established by modified Feeney method, and 42 rabbits having severe craniocerebral injury were randomly divided into two groups. The cell apoptosis was examined with TUNEL method. Then, water content and intracranial pressure were detected in various periods. At last, the association of cell apoptosis with cerebral edema and intracranial pressure was analyzed. Results The number of apoptosis cell and intracranial pressure in injury group arrived at a higher level after three days (P<0.01), while water content already got its peak after one day (P<0.01). According to correlation analysis, there was positive relationship between cell apoptosis and water content as well as intracranial pressure in various periods of craniocerebral injury, which was the same result of correlation and regression analysis in the population (N=36). Conclusion After traumatic craniocerebral injury, the number of apoptosis cells increases correspondingly with cerebral edema aggravating and intracranial pressure increasing. It is useful for relieving cerebral edema and decreasing intracranial pressure to reduce cell apoptosis which is the manifestation of secondary brain injury.