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三叉神经刺激对严重创伤性脑损伤的神经保护作用。

Neuroprotective Effects of Trigeminal Nerve Stimulation in Severe Traumatic Brain Injury.

机构信息

Northwell Neuromonitoring Laboratory, The Feinstein Institute for Medical Research, Manhasset, NY, USA.

Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, NY, USA.

出版信息

Sci Rep. 2017 Jul 28;7(1):6792. doi: 10.1038/s41598-017-07219-3.

Abstract

Following traumatic brain injury (TBI), ischemia and hypoxia play a major role in further worsening of the damage, a process referred to as 'secondary injury'. Protecting neurons from causative factors of secondary injury has been the guiding principle of modern TBI management. Stimulation of trigeminal nerve induces pressor response and improves cerebral blood flow (CBF) by activating the rostral ventrolateral medulla. Moreover, it causes cerebrovasodilation through the trigemino-cerebrovascular system and trigemino-parasympathetic reflex. These effects are capable of increasing cerebral perfusion, making trigeminal nerve stimulation (TNS) a promising strategy for TBI management. Here, we investigated the use of electrical TNS for improving CBF and brain oxygen tension (PbrO), with the goal of decreasing secondary injury. Severe TBI was produced using controlled cortical impact (CCI) in a rat model, and TNS treatment was delivered for the first hour after CCI. In comparison to TBI group, TBI animals with TNS treatment demonstrated significantly increased systemic blood pressure, CBF and PbrO at the hyperacute phase of TBI. Furthermore, rats in TNS-treatment group showed significantly reduced brain edema, blood-brain barrier disruption, lesion volume, and brain cortical levels of TNF-α and IL-6. These data provide strong early evidence that TNS could be an effective neuroprotective strategy.

摘要

颅脑损伤(TBI)后,缺血缺氧在进一步加重损伤过程中起主要作用,这一过程称为“继发性损伤”。保护神经元免受继发性损伤的致病因素一直是现代 TBI 管理的指导原则。刺激三叉神经通过激活延髓头端腹外侧区引起升压反应和改善脑血流(CBF)。此外,它通过三叉神经-脑血管系统和三叉神经-副交感反射引起脑血管扩张。这些作用能够增加脑灌注,使三叉神经刺激(TNS)成为 TBI 管理的有前途的策略。在这里,我们研究了使用电 TNS 来改善 CBF 和脑氧张力(PbrO),以减少继发性损伤。在大鼠模型中使用皮质控制冲击(CCI)产生严重 TBI,并在 CCI 后 1 小时内进行 TNS 治疗。与 TBI 组相比,TNS 治疗的 TBI 动物在 TBI 的超急性阶段表现出明显更高的全身血压、CBF 和 PbrO。此外,TNS 治疗组的大鼠显示出明显减少的脑水肿、血脑屏障破坏、病变体积以及大脑皮质 TNF-α和 IL-6 水平。这些数据提供了强烈的早期证据表明 TNS 可能是一种有效的神经保护策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/113b/5533766/5319721c9164/41598_2017_7219_Fig1_HTML.jpg

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