廓清疗法治疗脑创伤的实验研究

Clearance therapeusis treatment experimental traumatic brain injury

目的探讨廓清疗法在脑创伤早期治疗中的机制和作用。方法用改进的落体脑损伤模型复制脑创伤。把新西兰白兔随机分为假手术组、损伤对照组、廓清疗法组,每组10只。观察各组脑损伤6 h后的大体病理及显微镜检查,用干湿重法测定脑组织含水量,用ICP光谱分析法测定脑组织Na+、Ca2+含量,应用全自动生化分析仪检测脑组织LACT浓度,并用氨基酸分析仪测定脑组织Glu含量。结果与假手术对照组比较,脑外伤后脑组织含水量、脑组织中Glu、LACT及Na+、Ca2+含量显著升高(P<0.01)。脑创伤后采用廓清疗法,即适度降低灌注压(CPP)和较大量液体出入(使用甘露醇+速尿+大量生理盐水+白蛋白),能使脑组织含水量、Glu、LACT及Na+、Ca2+含量较创伤组明显减少(P<0.05)。结论脑外伤后脑组织含水量、脑组织中Glu、LACT及Na+、Ca2+含量显著升高,廓清疗法治疗脑创伤能使脑组织含水量、Glu、LACT及Na+、Ca2+含量较创伤组明显减少,提示廓清疗法治疗脑创伤有效,其机制是部分减少脑创伤后有害代谢物产生和促进其排出。

Objective To study the mechanism and effect of clearance therapeusis treatment in traumatic brain injury. Methods The rabbits traumatic brain injury model was made by utilizing a free-falling weight impactor device, rabbits were randomly divided into 3 groups （n=10 in each group）：sham operation,injury control group ,treatment group or clearance therapeusis group. The clearance therapeusis ,including mannital,frusemide,high dose albumin and a great quantity of normal saling invenously, were only carried out in treatment group. Histological observation for each group was carried at 6 hours postinjury. The water content of brain tissue was detected by dry-humid weight method,and the contents of Na^＋ and Ca^2＋ by ICP methods,the contents of lactic acid by automatic biochemistry analyzer,the contents of glutamate by automatic amino acid analyzer at 6 hours postinjury. Results The contents of brain tissue water,lactic acid,glutamate, Na^＋ and Ca^2＋ in control group was markedly higher than that of sham operation group （P 〈 0.01）. Those of the treatment group or the clearance therapeusis group had a signeficant fall at 6 hours pastinjury,comparing the injury control group （P〈0. 05）. Conclusion The contents of brain tissue water,lactic acid,glutamate, and Na^＋ and Ca^2＋ increased markedly after traumatic brain injury. The clearance therapeusis decrease the contents of injured brain tissue water, lactic acid,glutamate, and Na^＋ and Ca^2＋ at 6 hours postinjury, indicating clearance therapeusis was effective. The machanisms of clearance therapeusis treatment in traumatic brain injury would be it can partly decrease the product and promote the elimination of the injured brain.