Wu Hao, Jiang Li-dan, Wrede Karsten H, Ji Xun-ming, Zhao Xi-qing, Tian Xin, Gao Yu-fei, Ling Feng
Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China.
Chin Med J (Engl). 2009 Jul 5;122(13):1558-63.
Local hypothermia induced by intravascular infusion of cold saline solution effectively reduces brain damage in stroke. We further determined the optimal temperature of local hypothermia in our study.
Seventy-eight adult male Sprague Dawley rats (260 - 300 g) were randomly divided into 3 groups: group A, ischemia/reperfusion without cold saline infusion (n = 26) (control group); group B, infusion with 20 degrees C saline before reperfusion (n = 26); group C: infusion with 10 degrees C saline before reperfusion (n = 26). In each group, we chose 15 rats for monitoring physical indexes and the temperature of the brain (cortex and striatum) and body (anus), measurement of brain infarction volume, assessment of neurological deficits and the survival rate of reperfusion at 48 hours. Another 8 rats from each group was chosen for examining brain edema, another 3 from each group for histological observation by electron microscopy (EM) and light microscopy (LM) at 48 hours after reperfusion.
There was no significant difference among the 3 groups for physical indexes during the examination (F((2, 45)) = 0.577, P = 0.568; F((2, 45)) = 0.42, P = 0.78 for blood pressure and blood gas analysis, respectively). The brain temperature was significantly reduced in the group C compared to the other groups (F((2, 45)) = 37.074, P = 0.000; F((2, 45)) = 32.983, P = 0.000, for cortex and striatum temperature respectively), while the difference in rectal temperature between group A and B or C after reperfusion was not significant (F((2, 45)) = 0.17115, P = 0.637). And the brain infarct volume was significantly reduced in group C (from 40% +/- 10% in group A, 26% +/- 8% in group B, to 12% +/- 6% in group C, F((2, 45)) = 43.465, P = 0.000) with the neurological deficits improving in group C (chi(2) = 27.626, P = 0.000). The survival rate at 48 hours after 10 degrees C and 20 degrees C saline reperfusion was increased by 132.5% and 150%, respectively, as compared to the control group (chi(2) = 10.489, P = 0.005). The extent of the brain edema showed no significant difference (F((2, 21)) = 0.547, P = 0.587) after cold saline infusion compared to the control group. No obvious vascular injury was found by electron or light microscopy in either infusion group.
Regional hypothermia with 10 degrees C cold saline infusion can significantly decrease the infarction volume, improve the neurological deficits, and 10 degrees C seems to be the optimal temperature in inducing a cerebral protection effect during stroke. This procedure could be adopted as a further treatment for acute stroke patients.
血管内输注冷盐溶液诱导的局部低温可有效减轻中风后的脑损伤。在本研究中,我们进一步确定了局部低温的最佳温度。
78只成年雄性Sprague Dawley大鼠(260 - 300克)随机分为3组:A组,缺血/再灌注但不输注冷盐溶液(n = 26)(对照组);B组,再灌注前输注20℃盐溶液(n = 26);C组,再灌注前输注10℃盐溶液(n = 26)。每组中,选取15只大鼠监测身体指标、脑(皮层和纹状体)及身体(肛门)温度,测量脑梗死体积,评估神经功能缺损及48小时再灌注存活率。每组另选8只大鼠检测脑水肿,每组另选3只大鼠在再灌注后4小时通过电子显微镜(EM)和光学显微镜(LM)进行组织学观察。
检查期间3组的身体指标无显著差异(血压的F((2, 45)) = 0.577,P = 0.568;血气分析的F((2, 45)) = 0.42,P = 0.78)。与其他组相比,C组脑温显著降低(皮层温度的F((2, 45)) = 37.074,P = 0.000;纹状体温度的F((2, 45)) = 32.983,P = 0.000),而再灌注后A组与B组或C组之间的直肠温度差异不显著(F((2, 45)) = 0.17115,P = 0.637)。C组脑梗死体积显著减小(从A组的40%±10%、B组的26%±8%降至C组的12%±6%,F((2, 45)) = 43.465,P = 0.000),C组神经功能缺损改善(χ(2) = 27.626,P = 0.000)。与对照组相比,10℃和20℃盐溶液再灌注后48小时的存活率分别提高了132.5%和150%(χ(2) = 10.489,P = 0.005)。与对照组相比,冷盐溶液输注后脑水肿程度无显著差异(F((2, 21)) = 0.547,P = 0.587)。在任一输注组中,电子显微镜或光学显微镜均未发现明显的血管损伤。
输注10℃冷盐溶液进行局部低温可显著减小梗死体积,改善神经功能缺损,10℃似乎是中风期间诱导脑保护作用的最佳温度。该方法可作为急性中风患者的进一步治疗手段。