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[脑血管适应过程中的微循环变化]

[Microcirculatory changes in the development of the cerebrovascular adaptation].

作者信息

Kotani A, Song Z, Schaller C, Otsuka H, Nakase H, Sakaki T

机构信息

Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.

出版信息

No To Shinkei. 2001 Feb;53(2):165-71.

Abstract

Recently, long-term cerebrovascular adaptations after unilateral carotid ligation that increase the tolerance of the brain to subsequent episode of ischemia was reported(J Cereb Blood Flow Metab, 1998). However, the pathophysiological mechanisms underlying the phenomenon was unknown. We examined regional cerebral blood flow(rCBF) before, during and after subsequent ischemia in the development of the adaptation. Male Wistar rats(n = 18) were used. Unilateral(right) carotid artery ligation was performed 3 hours(group A: n = 8), 3 days(group B: n = 10) before forebrain ischemia. With bilateral carotid arteries occlusion, mean arterial blood pressure(MABP) was reduced by hypobaric hypotension down to 50 mmHg and maintained constant for 30 min. After hypotension, the experiment continued for 90 min. Local CBF were registered at 25(5 x 5) identical locations by laser Doppler scanning in the cortex during the experiment in bilateral hemispheres(at control phase, after the left carotid artery ligation, during ischemia and after hypotension). The physiological variable such as blood pressure and gas analysis were within normal range in all groups. There were no differences of rCBF between the right and left hemispheres in group A during the experiment. In group A, rCBF of both hemispheres significantly decreased after the ligation of the left carotid artery, during the induced ischemia (P < 0.05), and recovered to the value of before ischemia. Whereas, in group B rCBF of the left side(non-occluded side) decreased after the ligation of the left carotid artery, during the induced ischemia(P < 0.05), and recovered to the value of before ischemia, but rCBF of the right side(occluded side) decreased only during the induced ischemia(P < 0.05) and rCBF of the right side was significantly higher than the left brain after ligation of the carotid artery, during ischemia and after hypotension(P < 0.05). On the basis of these data, we concluded that cerebrovascular adaptations can be acquired by 3 days after unilateral carotid artery occlusion and the tolerance phenomenon is certainly attributed to microcirculatory improvement.

摘要

最近,有报道称单侧颈动脉结扎后会出现长期脑血管适应性变化,从而增加大脑对随后缺血发作的耐受性(《脑血流与代谢杂志》,1998年)。然而,该现象背后的病理生理机制尚不清楚。我们在适应性发展过程中,对后续缺血前、缺血期间和缺血后的局部脑血流量(rCBF)进行了检测。使用雄性Wistar大鼠(n = 18)。在前脑缺血前3小时(A组:n = 8)、3天(B组:n = 10)进行单侧(右侧)颈动脉结扎。通过双侧颈动脉闭塞,利用低压性低血压将平均动脉血压(MABP)降至50 mmHg并维持30分钟恒定。低血压后,实验持续90分钟。在实验过程中,通过激光多普勒扫描在双侧半球的皮质中25个(5×5)相同位置记录局部脑血流量(在对照期、左侧颈动脉结扎后、缺血期间和低血压后)。所有组的血压和气体分析等生理变量均在正常范围内。实验期间,A组左右半球的rCBF无差异。在A组中,双侧半球的rCBF在左侧颈动脉结扎后、诱导缺血期间显著降低(P < 0.05),并恢复到缺血前的值。而在B组中,左侧(未闭塞侧)的rCBF在左侧颈动脉结扎后、诱导缺血期间降低(P < 0.05),并恢复到缺血前的值,但右侧(闭塞侧)的rCBF仅在诱导缺血期间降低(P < 0.05),且在颈动脉结扎后、缺血期间和低血压后,右侧的rCBF显著高于左侧大脑(P < 0.05)。基于这些数据,我们得出结论,单侧颈动脉闭塞3天后可获得脑血管适应性,且耐受性现象肯定归因于微循环改善。

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