【摘要】 目的观察轻度急性等容血液稀释(ANH)对兔局灶性脑缺血再灌注后早期颈静脉血乳酸(VBL)、S100-β蛋白及肿瘤坏死因子-α(TNF-α)的影响。方法 18只新西兰大白兔随机分为假手术组(S组,n=6)、缺血再灌注组(IR组,n=6)及血液稀释-缺血再灌注组(HIR组,n=6)。参照Longa实验方法建立右大脑中动脉栓塞模型。S组只行血管分离,IR组经右大脑中动脉栓塞行局灶性脑缺血2 h后再灌注,HIR组缺血前20 min使用6%羟乙基淀粉(万汶130/0.4)行ANH,稀释目标Hct=30%。于缺血前(T0)、缺血1 h(T1)及再灌注后1 h(T2)、2 h(T3)、4 h(T4)分别抽取颈内静脉血检测VBL,另抽取颈内静脉血4 mL,经10%EDTA抗凝,3 000 r/min离心,取血清-70℃保存,采用酶联免疫吸附法(ELISA)测定TNF-α和S100-β蛋白含量。结果 IR组和HIR组T1、T2、T3、T4的VBL、S100-β蛋白水平较T0均升高(P<0.05),但HIR组的升高幅度低于IR组(P<0.05);3组T1、T2、T3、T4时TNF-α浓度均高于T0时(P<0.05,P<0.01),IR组和HIR高于S组(P<0.05,P<0.01),而IR组又高于HIR组(P<0.05)。结论以Hct=30%为目标实施轻度ANH,有利于兔缺血再灌注后早期脑组织的氧供和利用,减少炎症反应,降低继发性脑组织损害。更多还原

【Abstract】 Objective To investigate the effect of mild acute isovolemic hemodilution on VBL,S100-β and TNF-α after reperfusion of focal brain ischemia in rabbits. Methods Eighteen New Zealand rabbits were randomly divided into 3 groups(n=6): sham operated group(Group S),ischemia-reperfusion group(Group IR),and hemodilution-ischemia-reperfusion group(Group HIR).The right middle cerebral artery embolism model was constructed according to Longa′s method.Rabbits in Group S only received angiodiastasis as sham operation.Ischemia was created by embolism for 2 hours followed by reperfusion in rabbits of Group IR,while pre-dilution with 6% hetastarch(130/0.4) until Hct reached 30% 20 min before embolism were applied in rabbits of Group HIR.VBL,S100-β,TNF-α were measured at baseline(T0),1 h after ischemia(T1),and 1 h(T2),2 h(T3),and 4 h after reperfusion(T4). Results The levels of VBL and S100-β at T1,T2,T3,T4 were significantly increased compared with those at T0 in Group IR and HIR(P<0.05),with significantly more prominence in group IR(P<0.05).The concentrations of TNF-α at T1,T2,T3,T4 were significantly higher than those at T0 in all 3 groups(P<0.05,P<0.01),with significantly most prominence in Group IR,following with that in Group HIR(P<0.05). Conclusion Mild acute isovolemic hemodilution benefits the oxygen supply for brain tissue,reduces inflammatory reaction,and alleviates secondary brain injury after brain ischemia-reperfusion in rabbits.更多还原