家兔全脑缺血再灌注期血清白细胞介素6水平与星状神经节阻滞的关系

背景星状神经节阻滞可改善脑循环,调节免疫,降低血浆儿茶酚胺浓度,白细胞介素6是机体急性应激反应中最敏感重要的标志和介导物之一,在脑缺血性损伤中扮演着神经保护和神经毒性的双重作用.目的观察星状神经节阻滞对家兔全脑缺血再灌注期间血清白细胞介素6含量的影响,探讨星状神经节阻滞对全脑缺血再灌注损伤的作用效应.设计随机对照的动物实验.单位郧阳医学院附属太和医院麻醉科、郧阳医学院附属人民医院麻醉科.材料实验于2003-03在郧阳医学院实验中心及附属太和医院神经科学研究所进行动物实验,白细胞介素6检测试剂盒及测定工作由中国人民解放军总医院放射免疫研究所提供和协助完成.选择健康日本大耳白免28只,雌雄不拘,随机分成星状神经节组、盐水对照组、空白对照组和假手术组,每组7只.方法用手术法在所有动物星状神经节旁置入一导管,用六血管阻断法制作全脑缺血再灌注模型,星状神经节阻滞组在缺血15 min后松开动脉夹再灌注开始,同时从导管持续泵入2.5 g/L的布比卡因行左侧星状神经节阻滞,生理盐水对照组和空白对照组分别在松开动脉夹时从导管泵入生理盐水代替布比卡因和不用药,假手术组仅完成相应的手术操作而不夹闭动脉.采用放射免疫法测定缺血前、再灌注10 min,4,10,20及30时血清白细胞介素6的水平.主要观察指标各组实验动物在再灌注后各时点白细胞介素6水平变化.结果纳入本次实验的28只大耳白兔全部进入结果分析.白细胞介素6在各组均呈上升趋势,星状神经节阻滞组仅在再灌注30 h时高于假手术组,差异有显著性(321±52)和(299±45)ng/L,P＜0.05];与缺血前比较,生理盐水对照组在再灌注4 h开始显著升高(365±46)ng/L],空白对照组在再灌注10 h以后出现显著性升高(368±31)ng/L,P＜0.05].星状神经节阻滞组与假手术组,生理盐水对照组与空白对照组组间差异无显著性(P＞0.05);生理盐水对照组和空白对照组白细胞介素6水平在再灌注4～30 h时均高于假手术组,在再灌注10 h以后高于星状神经节阻滞组,差异均有显著性(P均＜0.05).星状神经节阻滞组白细胞介素6升高的水平较生理盐水对照组、空白对照组显著降低(P＜0.05).结论星状神经节阻滞可明显降低家兔全脑缺血再灌注期间血清白细胞介素6的水平,提示星状神经节阻滞对全脑缺血再灌注损伤具有一定的保护和治疗作用,可作为治疗脑缺血再灌注损伤的一种新的途径.

Relationship between serum interleukin-6 level and stellate ganglion block in rabbit brain during ischemic-reperfusion period

BACKGROUND: Stellate ganglion block has many functions by improving brain circulation, modulating immunity, reducing plasmic catecholamine content, interleukin-6 is one of the most sensitive and important predictors and mediators for acute organic stress response, playing neuroprotective and neurotoxic double roles in brain ischemic injury.OBJECTIVE: To observe the effect of stellate ganglion block in rat brain during ischemic-reperfusion period on the changes of serum interleukin-6,in order to probe the role of stellate ganglion block in brain ischemicreperfusional injury.DESIGN: Randomized controlled experimentation.SETTING: Anaesthesia Department of Taihe Hospital Mfiliated to Yunyang Medical College, and Anaesthesia Department of Renmin Hospital Affiliated to Yunyang Medical College.MATERIALS: This experiment on animals was carried out at the Experimental Center of Taihe Hospital Affiliated to Yunyang Medical College at March 2003, interleukin-6 reagent kit and determination was provided and conducted by the immunity research institute of Chinese People's Liberation Army General Hospital. Totally 28 big-ear healthy rabbits in which male or female was not limited were selected and randomly divided into stellate ganglion group, saline comparison group, blank comparison group and sham operation group with 7 rabbits in each group.METHODS: A pipe was set approximate to the stellate ganglion of all animals by operative method, six-vessels block method was used to simulate whole brain ischemic-reperfusion model, in stellate ganglion block group,artery clamp was lossen for reperfusiion at 15 minutes after ischemia, simultaneously 2.5 g/L bupivacaine was continuously pumped into left side of stellate ganglion for nerve block, which replaced by physical saline and nothing in respectively physical saline comparison group and blank comparison group, while rabbits in sham operation group were only subjected to surgery without artery clamp. RIA was used to determine serum interleukin-6 content at before ischemia, reperfusion of 10 minutes, 4 hours, 10hours, when 20 hours and 30 hours individually.MAIN OUTCOME MEASURES: Serum interleukin-6 content in each group at various post-reperfusional time points.RESULTS: Totally 28 big-ears white rabbits were enrolled in this experiment and all data was entered the result analysis. Interleukin-6 content was on an increasing tendency in all groups, while was higher in stellate ganglion block group than in sham operation group only at reperfusion 30time point, the difference has significance (321±52) and (299±45) ng/L,P ＜ 0.05]; Comparing to pre-ischemic group, interleukin-6 in physical saline group began increase remarkably from onset of reperfusion 4 hours(365±46) ng/L], but began obviously increase at reperfusion 10 hours in blank comparison group (368±31) ng/L, P ＜ 0.05]. The difference of interleukin-6 among stellate ganglion block group, sham operation group,physical saline group and blank comparison group does not have statistical significance (P＞0.05); the level of interleukin-6 in physical saline group and blank comparison group were higher than in sham at all reperfusion 4-30 hours, and even higher than in stellate ganglion group after reperfusion 10 hours, the difference has significant meaning (P ＜ 0.05). Moreover the increase of interleukin-6 content in stellate ganglion block group was remarkably lower than physical saline comparison group and blank comparison group (P ＜ 0.05).CONCLUSION: Stellate ganglion block may obviously reduce serum interleukin-6 level in rabbit brain during ischemic-reperfusion period, implying stellate ganglion block has a certain protective and curative function on the whole brain ischemic-reperfusion damage, and considered as a promising way in the treatment of brain ischemic-reperfusion damage.