摘要
目的观察心肺复苏早期脑水肿与血脑屏障变化的时间特点,研究乌司他丁对复苏后脑损伤的保护作用。方法SpragueDawley(SD)大鼠96只,随机分成正常对照组,手术对照组,复苏组(分复苏后即刻、0.5h、3h、6h、9h),药物组(给药后即刻、0.5h、3h、6h、9h),建立大鼠心肺复苏模型,检测脑组织水含量及EB含量,观察心肺复苏后各时点脑水肿及血脑屏障通透性的变化情况。结果心肺复苏后0.5h起就出现脑组织水含量的持续增加,6h后EB含量升高,电镜显示神经细胞胞质水肿,血管神经突起间隙(VR间隙)扩张。而药物组仅于复苏后0.5、3h有脑组织水含量的增加,6h后水含量下降,电镜观察神经细胞水肿减轻,VR间隙呈轻度局灶性扩张。给药后9h内均未见EB含量的升高。结论心肺复苏早期即出现脑水肿,开始以细胞毒性脑水肿为主,而后血脑屏障开放,促使血管源性脑水肿形成,乌司他丁可以通过抑制血脑屏障通透性,减轻脑水肿。
Objective To study the changes of cerebral edema and brain-blood barrier （BBB） at different time points after early cardiopulmonary resuscitation （CPR）, and to explore the mechanism of ulinastatin＇s protective effects against cerebral injury after resuscitation. Methods Ninety-six male Sprague Dawley （SD） rats were randomly divided into 12 groups （ n = 8, in each） ： normal control group, sham-operation group, CPR group and ulinastatin group which were further divided into 5 subgroups respectively on the base of time. The animal model of cardiac arrest （CA） was established by clamping endotracheal tube at the end of expiration. The contents of Evans Blue （EB） and brain water in cerebral tissue were assayed. Results Brain edema was obvious at 0.5 h after CPR, and was still elevated at 9 h while BBB opened （ P 〈 0. 05） at 6 h. Electron microscope revealed neuronal cytoplasm was swollen and nerve-vessel gap became dilated. In animals treated by ulinastatin, brain water content was increased （ P 〈 0.05） at 0.5 h to 3 h after CPR, decreased at 6 h, cellular swelling was less lightened and nerve-vessel gap became focal dilated slightly. EB content didn＇t change significantly. Conclusion CPR could cause cytotoxic edema, subsequently with the increased permeability of BBB, and vasogenic edema plays a critical role in brain edema formation. Ulinastatin could alleviate cerebral edema by suppressing BBB damage.
出处
《中华急诊医学杂志》
CAS
CSCD
2006年第4期338-341,共4页
Chinese Journal of Emergency Medicine
基金
温州市科技计划重点项目(Y2004A002)
温州市科技局计划项目(S2002A020)
关键词
心肺复苏
脑水肿
血脑屏障
乌司他丁
Cerebral edema
Blood-brain barrier
Cardiopulmonary resuscitation
Ulinastatin
