重度颅脑损伤后脑血管痉挛与NO及内皮素水平的研究
发布时间：2018-10-08 16:15
【摘要】：目的： 脑血管痉挛是颅脑损伤的基本病理改变之一。内皮素(ET)和一氧化氮(NO)是脑内两种重要的神经递质,可能是促发脑血管痉挛(Cerebral vasospasm, CVS)的重要物质。目前国内外对ET和NO在神经系统的作用以自发性蛛网膜下腔出血、脑缺血的研究为主,而对颅脑损伤后ET和NO作用的基础与临床研究较少。本文探讨重型颅脑外伤后血管痉挛与脑脊液NO及内皮素水平变化随时间变化的关系。 方法： 重型颅脑外伤患者68例,入院时GCS8分。患者入院后1天、第3天、第5天及第7、10天分别进行双侧大脑中动脉、颈内动脉颅外段TCD脑血流速度检测,同时留取脑脊液标本,采用放射免疫方法测定脑脊液中ET含量,采用硝酸还原酶法测定脑脊液中NO含量。依据经颅多普勒结果把68例患者分为脑血管痉挛组与非痉挛组,将所测数值进行统计学分析；依据脑血管痉挛的程度分成脑血管痉挛轻中症组、脑血管痉挛重症组和非脑血管痉挛组,将所测三组病人脑脊液中ET和NO的数值及正常对照组所测数值进行统计学分析。 结果： 患者(68例)中有54.4%(37例)发生脑血管痉挛：重度脑血管痉挛16例、中度脑血管痉挛11例和轻度脑血管痉挛10例。实验结果发现,重型颅脑损伤后患者脑脊液内皮素浓度均升高,而NO水平却明显下降(平0.05)。脑血管痉挛组ET与NO水平变化与经颅多普勒检查结果时间节点相一致。脑血管痉挛组脑脊液中ET浓度于伤后进行性升高,第3天达到高峰,此后维持较高水平,与非脑血管痉挛组之间存在显著性差异(P0.05),且重度脑痉挛组中ET浓度明显高于轻中度脑痉挛组(P0.01)。脑血管痉挛组脑脊液中NO含量低于正常对照组,有显著性差异,但非脑痉挛组脑脊液中NO含量与正常对照组比较在第3,5天有显著性差异(P0.05)。脑痉挛组脑脊液中NO浓度于伤后进行性下降,于伤后3天最明显,此后逐渐回升,伤后脑痉挛组与非脑痉挛组脑脊液中NO浓度有显著性差异(P0.05),且重度CVS组NO浓度于伤后3天内明显低于轻中度CVS组。 结论： 重度颅脑损伤容易发生脑血管痉挛,并且脑血管痉挛可能与脑脊液中内皮素水平升高和NO水平降低有关,脑血管痉挛程度与内皮素和NO变化水平在时间节点上相一致。
[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.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R651.15
本文编号：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.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R651.15
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