中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2012, Vol. 34 ›› Issue (5): 523-529.doi: 10.3881/j.issn.1000-503X.2012.05.015

• 论著 • 上一篇    下一篇

不同液体治疗方案对患者脑组织含水量、颅内压以及脑组织水通道蛋白-4和N-甲基-D-天冬氨酸受体-1表达的影响

王霞1,刘超2,张雪宁2,闵苏3,刘东4,魏珂3,董军3,罗洁3,刘小滨3   

  1. 1 天津市人民医院急诊科,天津 3001212 天津医科大学 第二医院放射科,天津 3002113 重庆医科大学 附属第一医院麻醉科,重庆 4000164 天津医科大学 第二医院神经外科,天津 300211
  • 收稿日期:2011-11-14 修回日期:2012-11-07 出版日期:2012-10-31 发布日期:2012-10-31
  • 通讯作者: 刘 超 电话:022-84112114 ,电子邮件:liuchao74001@126.com E-mail:liuchao74001@126.com
  • 基金资助:

    中华麻醉学会2009年度贝朗青年麻醉科学基金(30972831)

Effects of Different Liquid Therapies on Brain Water Content, Intracranial Pressure, and Expressions of Aquaporin-4 and N-methyl-D-aspartate Receptor-1 in Cerebral Tissue

WANG Xia1, LIU Chao2, ZHANG Xue-ning2, MIN Su3, LIU Dong4, WEI Ke3,DONG Jun3, LUO Jie3, LIU Xiao-bin3   

  1. 1Department of Emergency, Tianjin Union Medicine Centre, Tianjin 300121, China
    2Department of Radiology, the Second Hospital of Tianjin Medical University, Tianjin 300211, China
    3Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
    4Department of Neurosurgery, the Second Hospital of Tianjin Medical University, Tianjin 300211, China
  • Received:2011-11-14 Revised:2012-11-07 Online:2012-10-31 Published:2012-10-31
  • Supported by:

    Supported by the Berenger Youth Anesthesia Science Foundation of Chinese Society of Anesthesiologists (2009) (30972831)

摘要:

目的 探讨使用不同胶体以及不同晶胶比对患者颅内压、脑组织含水量和脑组织水通道蛋白-4(AQP-4)、N-甲基-D-天冬氨酸受体-1(NMDAR-1)表达及术后格拉斯哥昏迷量表评分的影响。 方法 按随机单位组析因设计设置2个干预因素,即胶体因素(2水平:4%琥珀酰明胶、6%中分子羟乙基淀粉)和晶胶比因素(2水平:0∶1、1∶1)的所有组合,将32例进行癫痫灶区切除术的患者随机分为4组(n=8)。术中监测颅内压;术后检测切除脑组织中的脑水含量和AQP-4和NMDAR-1的表达;测定术后2 h患者的格拉斯哥昏迷量表评分。结果 6% 中分子羟乙基淀粉较4% 琥珀酰明胶以及晶胶比1∶1较晶胶比0∶1均可增加液体治疗期间的平均颅内压(F=55.714, P=0.000;F=142.432, P=0.000)、脑水含量(F=31.477, P=0.000; F=84.896, P=0.000)以及AQP-4(F=37.205, P=0.000; F=149.652, P=0.014)和NMDAR-1的表达(F=29.664, P=0.000; F=65.951, P=0.000),两者的影响均呈相加效果(颅内压:F=11.056, P=0.002;脑组织含水量:F=8.007, P=0.008;AQP-4的表达:F=9.845, P=0.004;NMDAR-1的表达:F=5.020, P=0.033);但术后2 h的格拉斯哥昏迷量表评分差异无统计学意义(P>0.05)。结论 4% 琥珀酰明胶较6% 中分子羟乙基淀粉、晶胶比1∶1较晶胶比0∶1对脑含水量及颅内压的控制更好,更适合神经外科围手术期使用;但不同胶体和晶胶比的液体治疗方案对术后神经精神评分无明显影响,均可安全使用。

关键词: 液体治疗, 脑含水量, 颅内压, 水通道蛋白-4, N-甲基-D-天冬氨酸受体-1

Abstract:

Objective To explore the effects of different liquid therapies on the intracranial pressure, brain water content, and expressions of aquaporin-4 and N-methyl-D-aspartate-1 in the brain tissue. Methods Two intervention factors including the colloids (two levels: 4% gelofusine; 6% hydroxyethyl starch and sodium chloride injection) and the crystal/gel ratios (two levels: 0∶1; 1∶1) were set based on the results of the analysis of variance of factorial design. Thirty-two patient who had undergone epilepsy surgery were equally and randomly divided into four groups: group A (4% gelofusine, crystal/gel ratio 0∶1); group B (6% hydroxyethyl starch and sodium chloride injection, crystal/gel ratio 0∶1); group C (4% gelofusine, crystal/gel ratio 1∶1); and group D (6% hydroxyethyl starch and sodium chloride injection, crystal/gel ratio 1∶1). The intracranial pressure during operation was recorded. After the operation, the intracranial pressure and brain water content were measured and the expressions of aquaporin-4 and N-methyl-D-aspartate-1 in the brain tissue were determined with Western blot. Glasgow coma scores were obtained 2 hours after operation. Results The intracranial pressure (F=55.714, P=0.000; F=142.432, P=0.000) and the brain water content (F=31.477, P=0.000; F=84.896, P=0.000) significantly increased after the application of the 6% hydroxyethyl starch and sodium chloride injection and crystal/gel ratio 1∶1, and the expressions of aquaporin-4 (F=37.205, P=0.000; F=149.652, P=0.014) and N-methyl-D-aspartate-1(F=29.664, P=0.000; F=65.951, P=0.000) in the brain tissue significantly increased. There were additive effects between two of them (the intracranial pressure: F=11.056, P=0.002; the brain water content: F=8.007, P=0.008; the expression of aquaporin-4: F=9.845, P=0.004; and the expression of N-methyl-D-aspartate-1: F=5.020, P=0.033). However, the Glasgow coma score showed no significant difference after the administration (P>0.05). Conclusion The liquid therapy with 4% gelofusine and crystal/gel ratio 0∶1 can result in better control on the intracranial pressure, brain water content and expressions of aquaporin-4 and N-methyl-D-aspartate-1 in the brain tissue better than the liquid therapy with 6% hydroxyethyl starch and crystal/gel ratio 1∶1 during neurosurgery, although it may not improve the coma status.

Key words: treatment of liquids, brain water content, intracranial pressure, aquaporin-4, N-methyl-D-aspartate receptor-1

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