重度顱腦損傷后腦血管痙攣與NO及內(nèi)皮素水平的研究
發(fā)布時間：2018-10-08 16:15
【摘要】：目的： 腦血管痙攣是顱腦損傷的基本病理改變之一。內(nèi)皮素(ET)和一氧化氮(NO)是腦內(nèi)兩種重要的神經(jīng)遞質(zhì),可能是促發(fā)腦血管痙攣(Cerebral vasospasm, CVS)的重要物質(zhì)。目前國內(nèi)外對ET和NO在神經(jīng)系統(tǒng)的作用以自發(fā)性蛛網(wǎng)膜下腔出血、腦缺血的研究為主,而對顱腦損傷后ET和NO作用的基礎(chǔ)與臨床研究較少。本文探討重型顱腦外傷后血管痙攣與腦脊液NO及內(nèi)皮素水平變化隨時間變化的關(guān)系。 方法： 重型顱腦外傷患者68例,入院時GCS8分。患者入院后1天、第3天、第5天及第7、10天分別進行雙側(cè)大腦中動脈、頸內(nèi)動脈顱外段TCD腦血流速度檢測,同時留取腦脊液標本,采用放射免疫方法測定腦脊液中ET含量,采用硝酸還原酶法測定腦脊液中NO含量。依據(jù)經(jīng)顱多普勒結(jié)果把68例患者分為腦血管痙攣組與非痙攣組,將所測數(shù)值進行統(tǒng)計學分析；依據(jù)腦血管痙攣的程度分成腦血管痙攣輕中癥組、腦血管痙攣重癥組和非腦血管痙攣組,將所測三組病人腦脊液中ET和NO的數(shù)值及正常對照組所測數(shù)值進行統(tǒng)計學分析。 結(jié)果： 患者(68例)中有54.4%(37例)發(fā)生腦血管痙攣：重度腦血管痙攣16例、中度腦血管痙攣11例和輕度腦血管痙攣10例。實驗結(jié)果發(fā)現(xiàn),重型顱腦損傷后患者腦脊液內(nèi)皮素濃度均升高,而NO水平卻明顯下降(平0.05)。腦血管痙攣組ET與NO水平變化與經(jīng)顱多普勒檢查結(jié)果時間節(jié)點相一致。腦血管痙攣組腦脊液中ET濃度于傷后進行性升高,第3天達到高峰,此后維持較高水平,與非腦血管痙攣組之間存在顯著性差異(P0.05),且重度腦痙攣組中ET濃度明顯高于輕中度腦痙攣組(P0.01)。腦血管痙攣組腦脊液中NO含量低于正常對照組,有顯著性差異,但非腦痙攣組腦脊液中NO含量與正常對照組比較在第3,5天有顯著性差異(P0.05)。腦痙攣組腦脊液中NO濃度于傷后進行性下降,于傷后3天最明顯,此后逐漸回升,傷后腦痙攣組與非腦痙攣組腦脊液中NO濃度有顯著性差異(P0.05),且重度CVS組NO濃度于傷后3天內(nèi)明顯低于輕中度CVS組。 結(jié)論： 重度顱腦損傷容易發(fā)生腦血管痙攣,并且腦血管痙攣可能與腦脊液中內(nèi)皮素水平升高和NO水平降低有關(guān),腦血管痙攣程度與內(nèi)皮素和NO變化水平在時間節(jié)點上相一致。
[Abstract]:Objective: cerebral vasospasm is one of the basic pathological changes of craniocerebral injury. Endothelin (ET) and nitric oxide (NO) are two important neurotransmitters in the brain, which may be important substances in the development of cerebral vasospasm (Cerebral vasospasm, CVS). At present, the main role of ET and NO in nervous system is spontaneous subarachnoid hemorrhage and cerebral ischemia, but there are few basic and clinical studies on the effects of ET and NO after craniocerebral injury. The relationship between vasospasm and changes of NO and endothelin levels in cerebrospinal fluid (CSF) after severe craniocerebral trauma was studied. Methods: 68 patients with severe craniocerebral trauma were treated with GCS8. The blood flow velocities of bilateral middle cerebral artery (MCA) and extracranial TCD of internal carotid artery (ICA) were measured on day 1, day 3, day 5 and day 7 and day 10 after admission. Cerebrospinal fluid (CSF) samples were collected and the content of ET in cerebrospinal fluid (CSF) was measured by radioimmunoassay. The content of NO in cerebrospinal fluid was determined by nitrate reductase method. According to the results of transcranial Doppler, 68 patients were divided into cerebral vasospasm group and non-spastic group. The values of ET and NO in cerebrospinal fluid (CSF) of patients with cerebral vasospasm and non-cerebral vasospasm were analyzed statistically. Results: cerebral vasospasm occurred in 54. 4% (37 cases) of 68 patients: severe cerebral vasospasm in 16 cases, moderate cerebral vasospasm in 11 cases and mild cerebral vasospasm in 10 cases. The results showed that the concentration of endothelin in cerebrospinal fluid of patients with severe craniocerebral injury increased, while the level of NO decreased significantly (P < 0. 05). The changes of ET and NO levels in cerebral vasospasm group were consistent with the results of transcranial Doppler examination. In the cerebrospinal fluid of cerebral vasospasm group, the concentration of ET increased progressively after injury, reached the peak on the 3rd day, and maintained a high level after the injury. There was significant difference between the cerebral spasm group and the non-cerebral vasospasm group (P0.05), and the ET concentration in the severe cerebral spasm group was significantly higher than that in the mild to moderate cerebral spasm group (P0.01). The content of NO in cerebrospinal fluid of cerebral vasospasm group was significantly lower than that of normal control group (P0.05), but the content of NO in cerebrospinal fluid of non-cerebral spasm group was significantly higher than that of normal control group (P0.05). In the cerebral spasm group, the concentration of NO in cerebrospinal fluid gradually decreased after injury, was most obvious at 3 days after injury, and then increased gradually. The concentration of NO in cerebrospinal fluid of cerebral spasm group and non-cerebral spasm group was significantly different (P0.05), and the NO concentration in severe CVS group was significantly lower than that in mild to moderate CVS group within 3 days after injury. Conclusion: cerebral vasospasm is easy to occur in severe craniocerebral injury, and cerebral vasospasm may be related to the increase of endothelin level and the decrease of NO level in cerebrospinal fluid. The degree of cerebral vasospasm was consistent with the changes of endothelin and NO at the time node.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R651.15
本文編號：2257417
[Abstract]:Objective: cerebral vasospasm is one of the basic pathological changes of craniocerebral injury. Endothelin (ET) and nitric oxide (NO) are two important neurotransmitters in the brain, which may be important substances in the development of cerebral vasospasm (Cerebral vasospasm, CVS). At present, the main role of ET and NO in nervous system is spontaneous subarachnoid hemorrhage and cerebral ischemia, but there are few basic and clinical studies on the effects of ET and NO after craniocerebral injury. The relationship between vasospasm and changes of NO and endothelin levels in cerebrospinal fluid (CSF) after severe craniocerebral trauma was studied. Methods: 68 patients with severe craniocerebral trauma were treated with GCS8. The blood flow velocities of bilateral middle cerebral artery (MCA) and extracranial TCD of internal carotid artery (ICA) were measured on day 1, day 3, day 5 and day 7 and day 10 after admission. Cerebrospinal fluid (CSF) samples were collected and the content of ET in cerebrospinal fluid (CSF) was measured by radioimmunoassay. The content of NO in cerebrospinal fluid was determined by nitrate reductase method. According to the results of transcranial Doppler, 68 patients were divided into cerebral vasospasm group and non-spastic group. The values of ET and NO in cerebrospinal fluid (CSF) of patients with cerebral vasospasm and non-cerebral vasospasm were analyzed statistically. Results: cerebral vasospasm occurred in 54. 4% (37 cases) of 68 patients: severe cerebral vasospasm in 16 cases, moderate cerebral vasospasm in 11 cases and mild cerebral vasospasm in 10 cases. The results showed that the concentration of endothelin in cerebrospinal fluid of patients with severe craniocerebral injury increased, while the level of NO decreased significantly (P < 0. 05). The changes of ET and NO levels in cerebral vasospasm group were consistent with the results of transcranial Doppler examination. In the cerebrospinal fluid of cerebral vasospasm group, the concentration of ET increased progressively after injury, reached the peak on the 3rd day, and maintained a high level after the injury. There was significant difference between the cerebral spasm group and the non-cerebral vasospasm group (P0.05), and the ET concentration in the severe cerebral spasm group was significantly higher than that in the mild to moderate cerebral spasm group (P0.01). The content of NO in cerebrospinal fluid of cerebral vasospasm group was significantly lower than that of normal control group (P0.05), but the content of NO in cerebrospinal fluid of non-cerebral spasm group was significantly higher than that of normal control group (P0.05). In the cerebral spasm group, the concentration of NO in cerebrospinal fluid gradually decreased after injury, was most obvious at 3 days after injury, and then increased gradually. The concentration of NO in cerebrospinal fluid of cerebral spasm group and non-cerebral spasm group was significantly different (P0.05), and the NO concentration in severe CVS group was significantly lower than that in mild to moderate CVS group within 3 days after injury. Conclusion: cerebral vasospasm is easy to occur in severe craniocerebral injury, and cerebral vasospasm may be related to the increase of endothelin level and the decrease of NO level in cerebrospinal fluid. The degree of cerebral vasospasm was consistent with the changes of endothelin and NO at the time node.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R651.15
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