蛛网膜下腔出血伴迟发性脑血管痉挛高血流动力学治疗的研究

目的 探讨高血流动力学治疗对兔蛛网膜下腔出血（SAH）伴迟发性脑血管痉挛脑能量代谢的影响.方法 采用枕大池二次注血法制作SAH动物模型并随机分为正常组、SAH对照组和SA治疗组;应用微透析设备采集脑组织间液.利用高效液相色谱（HPLC）分析透析液中葡萄糖（Glu）、乳酸（Lac）及丙酮酸（Pyr）的含量,计算Lac/Pyr比值（L/P）.于光学显微镜下观察基底动脉病理学变化.结果 SAH各组兔的Glu水平较正常组均显著下降（均P〈0.01）,而Lac水平则明显上升（均P〈0.01）;SAH多巴酚丁胺治疗组与SAH未治疗组相比.透析液中Glu水平明显升高（P〈0.01）,Lac水平明显下降（P〈0.01）,L/P比值显著降低（P〈0.01）;高浓度多巴酚丁胺治疗组与低浓度多巴酚丁胺治疗组相比,Glu水平进一步升高,Lac水平进一步降低,L/P比值也随之降低.结论 兔SAH伴迟发性脑血管痉挛后经高血流动力学治疗,可通过增加脑灌注.维持细胞能量代谢,对脑组织起到保护作用.

High-hemodynamics In treatment of subarachnoid hemorrhage

Objective To investigate the effect of high-hemodynamics on cerebral metabolism after subarachnoid hemorrhage （SAH） in rabbits. Methods Rabbit SAH model was induced by injection of autogeneic blood into the cisterna magna. The animals were divided randomly into blank group, SAH group, and dobutamine-treated group, the later was further subdivided into high-dose dobutamine and low-dose dobutamine groups. Extracellular cerebral fluid （ECF） was collected by microdialysis, and the levels of glucose （Glu）, lactic acid （Lac）, pyruvic acid （Pyr） in ECF were measured by HPLC, the ratio of Lac and Pyr was calculated. Results the ECF levels of glucose （Glu） decreased and the levels of lactic acid （Lac） increased markedly in SAH group than in blank group. Glu levels in ECF and the ratio of Lac and Pyr （L/P） increased markedly in SAH treated group than that in untreated group, and the levels of Lac decreased. Compare to low-dose dobutamine group the Glu and the L/P increased more prominently in high-dose dobutamine group. Conclusion High-hemodynamics treatment may play a protective role in SAH rabbits by increasing cerebral perfusion and maintainincl cellular enerqv metabolism.