去骨瓣减压对心跳骤停大鼠脑复苏的影响

Effect of decompressive craniectomy on cerebral resuscitation of cardiac arrest rats

目的探讨去骨瓣减压对心跳骤停大鼠脑复苏的影响。方法选取成年雄性Wistar大鼠48只,随机分为假手术组(n=16)、对照组(n=16)、去骨瓣干预组(n=16)。每组又分为A(6 h)、B(12 h)、C(24 h)、D(48 h)4个亚组。对照组与去骨瓣干预组采用窒息致大鼠心脏骤停(CA)和心肺复苏(CPR)模型。去骨瓣干预组在大鼠心肺复苏成功1 h后行去骨瓣减压。假手术组仅行气管插管、股动静脉置管术。分别于各时间点取血和组织标本,以免疫组化染色法测定的内源性白蛋白渗出的面积百分比来表示BBB的破坏程度,ELISA法检测血清S100b蛋白质量浓度,TUNEL法检测细胞凋亡变化,HE染色观察海马及大脑皮质细胞大体形态。结果与假手术组比较,对照组及去骨瓣干预组BBB的破坏程度于6 h后开始加重,并持续上升至12 h并达到峰值,之后略有下降,差异具有统计学意义(P<0.05)。与对照组比较,去骨瓣干预组自主循环恢复(ROSC)后12 h显著降低(P<0.01),6 h、24 h、48 h亦降低(P<0.05)。与假手术组比较,对照组血清S100b蛋白在ROSC后6 h明显升高,并持续上升至12 h达峰值,24 h、48 h有所回落,差异具有统计学意义(P<0.01)。与对照组比较,去骨瓣干预组ROSC后6、12、24、48 h显著降低(P<0.01)。假手术组仅可见≤3个散在的凋亡细胞出现在皮质。对照组和去骨瓣干预组可见皮质有大量神经元、胶质细胞及部分血管内皮细胞发生凋亡。去骨瓣干预组细胞凋亡数量较对照组明显减少(P<0.05)。结论去骨瓣减压能减轻血脑屏障的破坏程度,降低大鼠心肺复苏后血清中S100 b蛋白的表达,减少细胞凋亡,从而减轻脑损伤。

Objective To explore the effect of decompressive craniectomy on cerebral resuscitation of cardiac arrest rats. Methods A total of 48 adult male Wistar rats were randomly divided into sham- operation group（ n = 16）,control group（ n = 16） and craniectomy intervention group（ n = 16）. Each group was further divided into four subgroups of A（ 6 h）,B（ 12 h）,C（ 24 h）,and D（ 48 h）. The control group and craniectomy intervention group adopt rat cardiac arrest（ CA） and cardiopulmonary resuscitation（ CPR） model caused by suffocation. Rats in the craniectomy intervention group operated decompressive craniectomy after 1 h of successfully cardiopulmonary resuscitation（ CPR）. The sham- operated group only had endotracheal intubation and femoral arteriovenous catheter. The blood and tissue samples were collected respectively at each time point,immune- histochemical staining method was used to detect the endogenous albumin leakage area percentage which showed the BBB damage,ELISA method was applied to detect the serum S100 b protein mass concentration,and TUNEL method was applied to detect the change of apoptosis,and HE staining was to observe the hippocampus and cerebral cortex cells form. Results Compared with the sham- operation group,BBB damage degree aggravated 6 h later in the control group and the decompressive intervention group,raised until the point of 12 h and reached the peak,then it was slightly down,the difference was statistically significant（ P〈0. 05）. Compared with the control group,the decom pressive intervention group＇s spontaneous circulation recovery（ ROSC） significantly decreased 12 h later（ P〈0. 01）,6 h,24 h and 48 h also decreased（ P 0.05）. Compared with the control group,control group＇ s serum S100 b protein in ROSC significantly increased 6 h later,raised to the peak at 12 h,and declined in 24 h and 48 h,there was statistically significant difference（ P〈0. 01）. Compared with the control group,the decompressive intervention group decreased significantly after ROSC at 6,12,24 h and 48 h（ P〈0. 01）. There were only less than 3 scattered apoptotic cells seen in cortex in the sham- operated group. A large number of neurons,glial cells and part of the vascular endothelial cell apoptosis were available in cortex in the control group and the decompressive intervention group. The number of cell apoptosis in the decompressive intervention group decreased significantly than that of the control group（ P〈0. 05）. Conclusion The decompressive craniectomy can reduce the damage rate of the blood brain barrier,decrease S100 b protein expression in serum after cardiopulmonary resuscitation（ CPR） in rats,and reduce the apoptosis so as to reduce the brain damage.