發(fā)布時(shí)間：2018-05-01 16:27

  本文選題：腦缺血 + 大腦中動(dòng)脈阻塞��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景腦卒中以其高發(fā)病率、高致死率、高復(fù)發(fā)率的特點(diǎn),目前是中國居民的第一位死因,給社會(huì)及家庭造成了嚴(yán)重的負(fù)擔(dān)。而急性缺血性腦卒中(即腦梗死)是最常見的腦卒中類型,約占全部腦卒中的60%~80%,加強(qiáng)針對其病因、發(fā)病機(jī)制、預(yù)防及治療的研究,可以為減少其發(fā)病率、降低其不良預(yù)后率提供更多可選擇的途徑。而可重復(fù)的、對缺血性卒中病理過程有較好模擬性的動(dòng)物模型是進(jìn)行相關(guān)缺血性腦損傷研究的一個(gè)至關(guān)重要的因素。線栓法制備的大鼠大腦中動(dòng)脈閉塞模型是目前應(yīng)用最多的一種急性局灶性腦缺血模型,其建模方法、梗死體積、神經(jīng)功能缺失均較穩(wěn)定,但因缺乏相對客觀、便捷的評價(jià)手段,仍有一定的建模失敗率。激光多普勒腦血流監(jiān)測可以準(zhǔn)確的反應(yīng)建模期間腦皮質(zhì)血液灌注的變化程度和持續(xù)時(shí)間。目的探討激光多普勒腦血流監(jiān)測在以線栓法制備大鼠大腦中動(dòng)脈閉塞模型時(shí)的評價(jià)作用,為模型制備的評價(jià)提供更加客觀的標(biāo)準(zhǔn)。方法分別將線栓插入30只SPF級Wistar Han大鼠頸內(nèi)動(dòng)脈顱內(nèi)段(16.0±0.5)、(18.0±0.5)和(20.0±0.5)mm,制備3種局灶性腦缺血模型(各10只)。缺血及再灌注后6 h對所有實(shí)驗(yàn)大鼠進(jìn)行Longa神經(jīng)行為學(xué)評分,然后依據(jù)顱底有無血凝塊及2,3,5氯化三苯基四氮染色后大腦中動(dòng)脈供血區(qū)有無梗死灶將其分為不全阻塞組、完全阻塞組及過深阻塞組3組,對阻塞頸內(nèi)動(dòng)脈顱內(nèi)段前后及拔出線栓再灌注后每只大鼠大腦中動(dòng)脈供血區(qū)腦皮質(zhì)的血流量以激光多普勒法進(jìn)行監(jiān)測記錄并進(jìn)行統(tǒng)計(jì)學(xué)分析。大腦中動(dòng)脈供血區(qū)腦皮質(zhì)的血流量以相對流量單位PU值表示;阻塞后及再灌注后的腦皮質(zhì)血流量變化以與阻塞前腦皮質(zhì)血流量的百分比表示。結(jié)果模型制作過程中,1只大鼠死亡;納入不全阻塞組9只,完全阻塞組15只,過深阻塞組5只。不全阻塞組線栓插入深度在(16.0±0.5)mm的大鼠有8只,不能完全阻止大腦前動(dòng)脈向大腦中動(dòng)脈的血流,缺血6 h后大鼠Longa評分0~1分;顱底動(dòng)脈環(huán)周圍無血凝塊,經(jīng)TTC染色后無梗死灶。完全阻塞組線栓插入深度在(18.0±0.5)mm的大鼠有9只,大腦前動(dòng)脈的血流被完全阻斷,缺血6 h后大鼠存在明顯的神經(jīng)功能缺失,Longa評分2~3分;顱底動(dòng)脈環(huán)周圍無血凝塊而TTC染色提示存在大腦中動(dòng)脈供血區(qū)的梗死灶。過深阻塞組線栓插入深度在(20.0±0.5)mm的大鼠有5只,可完全阻斷大腦前動(dòng)脈的血流,缺血6 h后大鼠神經(jīng)功能存在嚴(yán)重缺失,Longa評分3~4分;解剖可見顱底血凝塊,TTC染色后可見中動(dòng)脈供血區(qū)梗死灶。插入線栓后,不全阻塞組、完全阻塞組和過深阻塞組大鼠腦皮質(zhì)血流量均較阻塞前下降(分別為94±17比256±36、43±9比286±44、44±6比294±46,均P0.05),組間差異有統(tǒng)計(jì)學(xué)意義(F=56.57,P0.01),完全阻塞組和過深阻塞組血流量明顯低于不全阻塞組(均P0.05),完全阻塞組與過深阻塞組間差異無統(tǒng)計(jì)學(xué)意義(P0.05);3組與阻塞前腦皮質(zhì)血流量的百分比分別為(36.93±0.06)%、(15.09±0.02)%、(15.52±0.04)%,組間差異有統(tǒng)計(jì)學(xué)意義(F=39.14,P0.01)。再灌注后,不全阻塞組、完全阻塞組和過深阻塞組腦皮質(zhì)血流量(分別為213±31、147±17、96±14)均較阻塞后有明顯回升(均P0.05),組間差異有統(tǒng)計(jì)學(xué)意義(F=50.05,P0.01),過深阻塞組腦皮質(zhì)血流量明顯低于完全阻塞組(P0.05);3組與阻塞前腦血流量水平百分比分別為(83.10±0.02)%、(51.83±0.05)%、(33.49±0.09)%,差異有統(tǒng)計(jì)學(xué)意義(F=93.23,P0.01)。以激光多普勒監(jiān)測的腦皮質(zhì)血流量變化作為MCAO缺血模型制備成功的判斷標(biāo)準(zhǔn),其靈敏度和特異度要高于神經(jīng)行為學(xué)評分(93.33 vs 80.00,92.86 vs78.57)。結(jié)論以激光多普勒對腦血流進(jìn)行監(jiān)測,可作為判斷線栓法制備大鼠MCAO腦缺血模型成功的一種實(shí)時(shí)、便捷、微創(chuàng)、客觀可靠的評價(jià)標(biāo)準(zhǔn),其靈敏度和特異度均高于神經(jīng)行為學(xué)評分。
[Abstract]:Background cerebral apoplexy, with its high incidence, high mortality and high recurrence rate, is the first cause of death in Chinese residents, causing serious burden to society and family. Acute ischemic stroke (cerebral infarction) is the most common stroke type, which accounts for 60%~80% of all stroke, and strengthens its etiology, pathogenesis, prevention and prevention. And the study of treatment can provide more alternative ways to reduce its incidence and reduce its bad prognosis. But repeatable, a better simulated animal model for the pathological process of ischemic stroke is a vital factor in the study of ischemic brain damage. The rat middle cerebral artery occlusion model is prepared by the thread embolus method. A model of acute focal cerebral ischemia is the most widely used model at present. Its modeling method, infarct volume and neural function loss are all stable. However, there is still a certain failure rate of modeling because of lack of relative objective and convenient evaluation methods. Laser Doppler cerebral blood flow monitoring can be accurate during the process of cerebral cortex blood perfusion during the reaction modeling. Objective to investigate the role of laser Doppler cerebral blood flow monitoring in the evaluation of rat middle cerebral artery occlusion model by thread emboli, and to provide more objective criteria for the evaluation of the model preparation. Methods the thread plug was inserted into the intracranial segment of the internal carotid artery of 30 SPF Wistar Han rats (16 + 0.5), (18 + 0.5) and (20 + 0.5) m, respectively. M, 3 focal cerebral ischemia models were prepared (10 rats each). 6 h after ischemia and reperfusion, all experimental rats were evaluated by Longa neurobehavioral score. Then the infarcts in the middle cerebral artery were divided into incomplete occlusion group based on whether the skull base had blood clots and 2,3,5 chlorination three phenyl four nitrogen, and the total occlusion group and the over deep obstruction group were 3. The blood flow of the cerebral cortex in the cerebral cortex of the middle cerebral artery of each rat after the occlusion of the intracranial segment of the internal carotid artery and the pulling out thread embolus was monitored and recorded by the laser Doppler method. The blood flow of the cerebral cortex in the blood supply area of the middle cerebral artery was represented by the relative flow single PU value; the cerebral cortex after the obstruction and after the reperfusion was carried out. In the process of making the model, 1 rats died, 9 rats were included in the incomplete obstruction group, 15 in the complete obstruction group and 5 in the deep blocking group. The insertion depth of the incomplete occlusion group was 8 in the rats of (16 + 0.5) mm, and the anterior cerebral artery could not be completely prevented from the middle cerebral artery. Blood flow, Longa score 0~1 score of rats after 6 h ischemia; no blood clot around the skull base artery ring, no infarct after TTC staining. There were 9 rats with deep occlusion group insertion depth (18 + 0.5) mm. The blood flow of the anterior cerebral artery was completely blocked. After 6 h of ischemia, the rats had obvious nerve function loss, Longa score 2~3, and cranial artery ring. There was no blood clot around and TTC staining showed the presence of infarct in the middle cerebral artery supply area. There were 5 rats (20 + 0.5) mm in the deep occlusion group, which could completely block the blood flow of the anterior cerebral artery. After 6 h ischemia, the nerve function was seriously missing, the Longa score was 3~4, and the blood clot of the skull base was visible and the TTC staining was visible. Infarcts in the middle artery supply area. The cerebral cortex blood flow of the rats in the complete occlusion group and the over deep block group was lower than that before the occlusion (94 + 17 to 256 + 36,43 + 9, 286 + 44,44 + 6 and 294 + 6, 294 +, respectively, P0.05). The difference between the groups was statistically significant (F= 56.57, P0.01). The blood flow of the complete obstruction group and the over deep block group was clear. There was no significant difference in the total occlusion group (P0.05). There was no significant difference between the complete occlusion group and the over deep obstruction group (P0.05); the percentage of the 3 groups and the obstructive anterior cerebral cortex was (36.93 + 0.06)%, (15.09 + 0.02)%, (15.52 + 0.04)%, and the difference between the groups was statistically significant (F=39.14, P0.01). The cerebral cortex blood flow (213 + 31147 + 17,96 + 14 respectively) in the deep blocking group was significantly higher than that of the obstruction (P0.05). The difference between the groups was statistically significant (F=50.05, P0.01). The cerebral cortex blood flow was significantly lower than that in the complete occlusion group (P0.05), and the percentage of the 3 group and the obstructive forebrain blood flow was (83.10 + 0.02)%, (51.83 + 0.05)%, respectively. (33.49 + 0.09)%, the difference was statistically significant (F=93.23, P0.01). The change of cerebral cortex blood flow measured by laser Doppler was used as a criterion for the success of MCAO ischemia model, and its sensitivity and specificity were higher than that of neurobehavioral score (93.33 vs 80.00,92.86 vs78.57). A real-time, convenient, minimally invasive, objective and reliable evaluation criterion for the success of the rat MCAO cerebral ischemia model prepared by the method of thread emboli was used to evaluate the sensitivity and specificity of the rat model. The sensitivity and specificity of the evaluation were higher than that of the neurobehavioral score.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3;R-332

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