长期持续脑脊液外引流对蛛网膜颗粒的影响研究

发布时间：2018-06-13 13:48

本文选题：脑积水 + 蛛网膜颗粒　；参考：《川北医学院》2017年硕士论文

【摘要】：目的:长时间持续脑脊液外引流的条件下蛛网膜颗粒(arachnoid granulations,AG)是否有变化,以及出现蛛网膜颗粒变化的时间规律。通过了解持续脑脊液外引流对蛛网膜颗粒的影响特点,指导脑脊液外引流在临床上的应用。方法:随机选取26只健康成年杂种犬作为研究对象,2只作为空白对照组,将24只动物作为实验手术对象,持续腰大池引流动物模型在造模成功后随机平均分成4组,分别命名A、B、C、D组,每组6只。空白对照组不做特殊处理,手术组在行腰大池引流成功后测量脑脊液压力数据备用。A组动物夹闭腰大池引流管,行头颅核磁共振(magnetic resonance imaging,MRI)检查。B组动物持续引流14天,夹闭24小时,然后测脑脊液压力,MRI头颅扫描测量脑室相关径线,处死杂种犬经心脏灌注4%多聚甲醛溶液后取材,其中3只犬将含有蛛网膜颗粒的上矢状窦、横窦组织连续切片,切片厚度为0.5μm,进行苏木素-依红(HE)染色,光镜下观察蛛网膜颗粒大体结构。另3只犬经取材后分别行透射电镜观察,明确蛛网膜颗粒表面结构和内部超微结构。C组及D组动物分别持续引流21天及28天,后续处理方法同B组。空白对照组动物蛛网膜颗粒行光镜及电镜观察内外部结构。结果:1.通过腰椎穿刺制作脑脊液外引流模型,在引流不同时期测量颅内压力,B、C、D组穿刺成功后分别引流2、3、4周后测量颅内压,结果提示明显低于A组对照组。再分别夹闭B、C、D组腰池引流24小时后测量颅内压,C、D组颅内压均高于A组。2.引流组腰池夹闭24小时后核磁共振测量各组动物脑室相关径线并计算脑室指数,B、C、D组脑室指数分别与A组对照组进行比较,各组比较均无明显差异(P0.05),脑实质未见明显异常。3.蛛网膜颗粒光镜下观察形态不一,内皮细胞丰富,纤维囊发达,形成管状孔道结构。透射电镜下对比脑脊液引流前后蛛网膜颗粒内皮细胞,均可见丰富囊泡存在,指状突起明显,蛛网膜颗粒核心部分蛛网膜细胞与胶原纤维交织,包含多形细胞等细胞成分。结论:1.蛛网膜颗粒在低压环境中4周后未见明显萎缩,蛛网膜颗粒内皮细胞仍具脑脊液转运功能,持续引流脑脊液4周内不会诱发脑积水,使用腰池引流在4周内相对安全。2.腰大池持续引流脑脊液3周后,夹闭腰池引流,颅内压升高,蛛网膜颗粒形态变化不明显,仍具备脑脊液吸收功能,提示颅内持续低压可能影响经蛛网膜颗粒途径以外的其他脑脊液吸收途径。3.犬蛛网膜颗粒形态不一,内皮细胞指状突起明显,囊泡丰富,内部纤维囊发达,形成管状孔道结构,蛛网膜颗粒核心部分蛛网膜细胞与胶原纤维交织,包含多形细胞等细胞成分。
[Abstract]:Objective: to study whether arachnoid granulation (AGG) of arachnoid granulation changes and the time rule of arachnoid granulation under the condition of continuous cerebrospinal fluid drainage for a long time. To understand the effect of continuous cerebrospinal fluid drainage on arachnoid granules, the clinical application of cerebrospinal fluid drainage was guided. Methods: 26 healthy adult mongrel dogs were randomly selected as the control group and 24 animals were selected as the experimental objects. The model of continuous lumbar cistern drainage was divided randomly into 4 groups after the successful establishment of the model. Six rats in each group were named as group A, B, C, D, respectively. There was no special treatment in the blank control group. The pressure data of cerebrospinal fluid were measured in the operation group after successful lumbar cistern drainage. The drainage tube of the lumbar cistern was clamped by the animals in the group A, and the drainage was continued for 14 days in the group B by magnetic resonance imaging. After 24 hours clipping, cerebrospinal fluid pressure and MRI cranial scanning were used to measure the relative diameters of the ventricles. The dogs were sacrificed after perfusion of 4% paraformaldehyde solution through the heart. Three of the dogs were sectioned into the superior sagittal sinus and transverse sinus tissue containing arachnoid granules. The thickness of the section was 0.5 渭 m, and the structure of arachnoid granules was observed under light microscope. The surface structure and internal ultrastructure of arachnoid granules in group C and group D were observed by transmission electron microscope respectively for 21 days and 28 days, respectively. The follow-up treatment was the same as that in group B. The internal and external structures of arachnoid granules in blank control group were observed by light microscope and electron microscope. The result is 1: 1. The model of cerebrospinal fluid external drainage was made by lumbar puncture. The intracranial pressure was measured at different stages of drainage. The intracranial pressure was measured after 2 weeks of drainage and 3 weeks later. The results showed that the intracranial pressure in group A was significantly lower than that in group A. The intracranial pressure in group C was higher than that in group A after 24 hours of lumbar cistern drainage. After 24 hours of lumbar cistern occlusion in drainage group, the ventricular relative diameters were measured by MRI and the ventricular index was calculated. The ventricular index of group D was compared with that of group A, and there was no significant difference between each group and group A (P 0.05), and there was no obvious abnormality in cerebral parenchyma. The morphology of arachnoid granules was different under light microscope, the endothelial cells were abundant, the fibrous sacs were well developed, and the tubular pore structure was formed. Compared with those before and after cerebrospinal fluid drainage, there were abundant vesicles, obvious digital processes, interlaced arachnoid cells with collagen fibers and polymorphic cells under transmission electron microscope. Conclusion 1. There was no obvious atrophy of arachnoid granules in low pressure environment after 4 weeks. The endothelial cells of arachnoid granules still had the function of cerebrospinal fluid transport. Continuous drainage of cerebrospinal fluid did not induce hydrocephalus within 4 weeks. It was relatively safe to use lumbar cistern drainage in 4 weeks. After 3 weeks of continuous drainage of cerebrospinal fluid from the greater lumbar cistern, the drainage of lumbar cistern was clipped, the intracranial pressure was increased, the morphology of arachnoid granules was not obvious, and it still had the function of cerebrospinal fluid absorption. The results suggest that continuous intracranial depression may affect cerebrospinal fluid (CSF) absorption pathways other than the arachnoid granule pathway. The morphology of the canine arachnoid granules is different, the endothelial cells have obvious phalanoid processes, the vesicles are abundant, and the internal fibrous capsules are developed, forming the tubular pore structure. The arachnoid cells in the core of the arachnoid granules are intertwined with collagen fibers. Contains polymorphic cells and other cell components.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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