Tomita Y, Sawauchi S, Beaumont A, Marmarou A
Division of Neurosurgery, Medical College of Virginia, Richmond, Virginia, USA.
Acta Neurochir Suppl. 2000;76:213-6. doi: 10.1007/978-3-7091-6346-7_43.
It is well-documented that acute subdural hematoma (ASDH) following diffuse traumatic brain injury (dTBI) contributes to severe disability and high mortality. The objective of this study was to characterize edema formation in a model of ASDH and ASDH following dTBI. Eighteen Sprague-Dawley rats were separated into three groups: Sham operated (n = 6), ASDH (n = 6), ASDH following dTBI (n = 6). Diffuse TBI was produced via the Impact-Acceleration Model [10]. ASDH was induced in the left hemisphere using the well-described method [11]. Total tissue water content was determined 4 hours after TBI utilizing wet-weight/dry-weight assessment. Our results show that ASDH causes a significant increase in tissue water content in the left hemisphere (79.2 +/- 0.7%) compared with the contralateral hemisphere (78.5 +/- 0.5%, p = 0.009). Animals exposed to ASDH following dTBI had significantly greater edema formation than those with ASDH (right: 80.9 +/- 0.4%, left: 80.5 +/- 0.7, p = 0.008). There was no significant difference between the left and right hemisphere. We conclude that edema formation in ASDH is worsened by the combination of dTBI and ASDH. Furthermore a diffuse and focal injury in combination retain the features of the diffuse injury, but with increased severity. Further studies are required to elucidate the synergistic mechanisms involved in these pathological processes.
充分的文献记载表明，弥漫性创伤性脑损伤（dTBI）后的急性硬膜下血肿（ASDH）会导致严重残疾和高死亡率。本研究的目的是在ASDH模型以及dTBI后的ASDH模型中描述水肿形成情况。18只Sprague-Dawley大鼠被分为三组：假手术组（n = 6）、ASDH组（n = 6）、dTBI后的ASDH组（n = 6）。通过撞击-加速模型[10]造成弥漫性TBI。采用已充分描述的方法[11]在左半球诱导ASDH。在创伤性脑损伤4小时后，利用湿重/干重评估法测定组织总含水量。我们的结果显示，与对侧半球（78.5 +/- 0.5%，p = 0.009）相比，ASDH导致左半球组织含水量显著增加（79.2 +/- 0.7%）。与单纯ASDH组动物相比，dTBI后发生ASDH的动物水肿形成明显更严重（右侧：80.9 +/- 0.4%，左侧：80.5 +/- 0.7，p = 0.008）。左右半球之间无显著差异。我们得出结论，dTBI和ASDH共同作用会使ASDH中的水肿形成加剧。此外，弥漫性损伤和局灶性损伤共同存在时保留了弥漫性损伤的特征，但严重程度增加。需要进一步研究以阐明这些病理过程中涉及的协同机制。
