本文選題：蛛網(wǎng)膜下腔出血 + 早期腦損傷　； 參考：《川北醫(yī)學(xué)院》2014年碩士論文

【摘要】：背景與目的：蛛網(wǎng)膜下腔出血（subarachnoid hemorrhage，SAH）是高病死率和高致殘率的腦血管疾病之一，分為自發(fā)性和外傷性兩類。由顱內(nèi)動(dòng)脈瘤破裂所致的SAH占所有自發(fā)性SAH的比例高達(dá)80%左右，又稱動(dòng)脈瘤性蛛網(wǎng)膜下腔出血，其致死率和致殘率極高，出血后3天內(nèi)死亡率可達(dá)45%。學(xué)者認(rèn)為出血后的早期腦損傷（early brain injury，EBI）是其高死亡率和致殘率的主要因素之一。高壓氧治療（hyperbaric oxygentherapy，HBOT）是在高于一個(gè)大氣壓的環(huán)境里吸入100%的氧，目前已廣泛應(yīng)用于多種疾病的治療，由于SAH患者病情變化快且風(fēng)險(xiǎn)大，高壓氧應(yīng)用于SAH的早期治療研究極少。本研究采用頸內(nèi)動(dòng)脈血管內(nèi)穿刺法建立大鼠SAH動(dòng)物模型，觀察大鼠腦皮質(zhì)中P53和Caspase-3的表達(dá)情況，以及高壓氧干預(yù)后大鼠神經(jīng)行為學(xué)、死亡率和腦皮質(zhì)中P53和Caspase-3的表達(dá)變化。 方法：選取體重為280-320g的健康成年雄性SD大鼠100只，，隨機(jī)分為正�？瞻讓�(duì)照組10只、假手術(shù)組（sham組）30只、蛛網(wǎng)膜下腔出血組（SAH組）30只、高壓氧干預(yù)的SAH組（HBOT+SAH組）30只；除空白對(duì)照組外，其余各組按實(shí)驗(yàn)動(dòng)物處死取標(biāo)本時(shí)間再分為24h、48h、72h三個(gè)亞組，各亞組10只�？瞻讓�(duì)照組不做任何特殊處理，常規(guī)飼養(yǎng)3天后麻醉、灌注、取腦組織標(biāo)本保存；SAH組和HBOT+SAH組均用頸內(nèi)動(dòng)脈血管內(nèi)穿刺法建模，建模成功后除HBOT+SAH組大鼠待麻醉蘇醒后行高壓氧治療外，其余飼養(yǎng)環(huán)境和術(shù)后護(hù)理均一樣；sham組建模過程與SAH組相同，但不刺破血管。sham組、SAH組和HBOT+SAH組分別于建模成功后24h、48h、72h記錄各亞組大鼠神經(jīng)行為學(xué)評(píng)分和死亡率，然后麻醉、灌注、取各亞組大鼠腦組織保存。采用免疫組織化學(xué)法檢測(cè)大鼠腦皮質(zhì)中P53和Caspase-3的表達(dá)情況。 使用Motic Image Advance3.2圖像分析系統(tǒng)對(duì)免疫組織切片進(jìn)行分析，計(jì)算其陽性細(xì)胞百分比，Microsoft office excel2003軟件錄入數(shù)據(jù)，正態(tài)分布計(jì)量資料以S表示。采用spss19.0軟件進(jìn)行數(shù)據(jù)分析，比較前進(jìn)行正態(tài)性和方差齊性檢驗(yàn)，兩組間比較采用t檢驗(yàn)，各亞組間兩兩比較采用SNK法（q檢驗(yàn)），P＜0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1.死亡率：空白對(duì)照組和假手術(shù)組大鼠死亡率均為0，兩組比較無統(tǒng)計(jì)學(xué)意義；SAH組和HBOT+SAH組總死亡率分別為40%和16.67%，兩組死亡率比較有統(tǒng)計(jì)學(xué)意義（P＜0.05）；SAH組和HBOT+SAH組在24h內(nèi)死亡率分別為23.33%和13.33%，24h內(nèi)兩組死亡率比較無統(tǒng)計(jì)學(xué)差異（P＞0.05）。 2.神經(jīng)行為學(xué)評(píng)分：SAH組與HBOT+SAH組在24h、48h兩個(gè)亞組比較無差異（P＞0.05）；但HBOT+SAH組中72h亞組的評(píng)分明顯低于SAH組中72h亞組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；SAH組中三個(gè)亞組間兩兩比較無明顯差異（P＞0.05）；HBOT+SAH組中三亞組間兩兩比較：24h亞組與48h亞組間比較無統(tǒng)計(jì)學(xué)意義（P＞0.05）；24h亞組與72h亞組、48h亞組與72h亞組比較均有統(tǒng)計(jì)學(xué)意義（P＜0.05）。 3.P53在大腦皮質(zhì)中陽性表達(dá)為細(xì)胞核呈棕褐色或棕黃色顆粒，并伴有少量胞質(zhì)表達(dá)。空白對(duì)照組和假手術(shù)組均有少量表達(dá)，但兩組比較無統(tǒng)計(jì)學(xué)意義（P＞0.05）；SAH三亞組間兩兩比較，僅24h與48h亞組P53陽性表達(dá)細(xì)胞百分比無差異；SAH各亞組比對(duì)應(yīng)sham各亞組陽性表達(dá)明顯增多，有統(tǒng)計(jì)學(xué)意義（P＜0.05）；HBOT+SAH組三亞組間兩兩比較均有統(tǒng)計(jì)學(xué)意義；P53在HBOT+SAH組48h、72h亞組表達(dá)低于相對(duì)應(yīng)的SAH兩亞組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.01）；HBOT+SAH-24h組與SAH-24h組比較無差異（P＞0.05）。 4.Caspase-3在胞質(zhì)上表達(dá)，陽性表達(dá)為棕黃色顆粒�？瞻讓�(duì)照組和假手術(shù)組均處于正常低水平表達(dá)，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；SAH各亞組比對(duì)應(yīng)sham各亞組陽性表達(dá)明顯增多，有統(tǒng)計(jì)學(xué)意義（P＜0.05）；SAH組各時(shí)間亞組間兩兩比較均有差異；HBOT+SAH各亞組間兩兩比較差異有統(tǒng)計(jì)學(xué)意義。Caspase-3在SAH組與HBOT+SAH組比較：在24h、48h、72h亞組中均有統(tǒng)計(jì)學(xué)意義（P＜0.05） 結(jié)論： 1.大鼠SAH后早期腦損傷與腦皮質(zhì)中P53和Caspase-3的表達(dá)增加有關(guān)。 2.高壓氧治療能降低大鼠SAH后早期（72小時(shí)內(nèi)）的總死亡率，并在一定程度上改善神經(jīng)功能，對(duì)治療EBI有一定作用，但對(duì)降低24h內(nèi)大鼠死亡率效果不明顯。 3.高壓氧可能通過降低P53和Caspase-3的表達(dá)，從而對(duì)SAH后早期腦損傷起保護(hù)作用。
[Abstract]:Background and objective: subarachnoid hemorrhage (SAH) is one of the high mortality and high disability rate of cerebrovascular disease, which is divided into two types of spontaneous and traumatic. The proportion of SAH caused by intracranial aneurysm rupture is about 80% of all spontaneous SAH, also known as aneurysmal subarachnoid hemorrhage, its mortality and cause The mortality rate is very high, the death rate within 3 days after bleeding can reach 45%. scholar. The early brain injury after bleeding (early brain injury, EBI) is one of the main factors of high mortality and disability. The hyperbaric oxygen therapy (hyperbaric oxygentherapy, HBOT) is inhaling 100% oxygen in the atmosphere above a atmospheric pressure, and is now widely used in a variety of diseases. The treatment of the disease, due to the rapid change and risk of SAH patients, is very rare in the early treatment of SAH. This study established rat SAH animal model by intravascular puncture of internal carotid artery, observed the expression of P53 and Caspase-3 in the rat brain cortex, and the neurobehavioral, mortality and cerebral cortex of rats after hyperbaric oxygen drying. Changes in the expression of P53 and Caspase-3 in the mass.
Methods: 100 healthy adult male SD rats with a weight of 280-320g were randomly divided into 10 normal blank control group, 30 sham operation group (Group sham), 30 subarachnoid hemorrhage group (group SAH) and 30 SAH group (group HBOT+SAH) with hyperbaric oxygen intervention (group HBOT+SAH). 48h, 72h three subgroups, each subgroup 10. The blank control group did not do any special treatment, the routine feeding 3 days after anesthesia, perfusion, the brain tissue specimens preserved, SAH and HBOT+SAH group were modeled by internal carotid artery puncture method, after the modeling was successful, after the HBOT+SAH group rats were awakened after the anesthesia and hyperbaric oxygen treatment, the rest of the environment and the operation of the environment and the operation. The modeling process of the sham group was the same as that in the SAH group, but it did not break the blood vessel.Sham group, and the SAH and HBOT+SAH groups respectively recorded the neurobehavioral score and mortality of each subgroup of the subgroups after the successful modeling, 24h, 48h, 72h, and then anaesthetized and perfused the brain tissue of the subgroups of the rats. The Immunochemistry method was used to detect P in the cerebral cortex of rats. The expression of 53 and Caspase-3.
The Motic Image Advance3.2 image analysis system was used to analyze the immune tissue section and calculate the percentage of the positive cells. The Microsoft office Excel2003 software was recorded in the data. The normal distribution measurement data were expressed in S. The spss19.0 software was used to analyze the data, and the normal and variance homogeneity tests were carried out before the comparison, and the two groups were compared with t. The SNK method (q test) was used for comparison between the two subgroups. P < 0.05 had statistical significance.
Result錛

本文編號(hào)：1797246