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背景:大量研究报道了全脑缺血再灌注损伤模型形态学上的变化,但是,再灌注早期皮质超微结构的变化、特别是血脑屏障的变化报道较少。目的:探讨全脑缺血再灌注损伤大鼠早期脑皮质神经元、胶质细胞和血脑屏障的变化,为临床治疗提供可靠的依据。设计:随机对照的实验研究。单位:北京天坛医院神经外科、麻醉科和电镜室。材料:实验于2003-02/2004-02在首都医科大学附属北京神经外科研究所对6只Wistar大鼠进行研究。随机分为2组,缺血再灌注组(3只)和假手术对照组(3只)。干预:制备大鼠全脑缺血再灌注模型。缺血组于缺血再灌注1h、假手术组于手术后1h取脑,利用电镜技术观察皮质超微结构的变化。主要观察指标:皮质超微结构变化。结果:缺血再灌注早期(1h)皮质神经细胞发生不同程度的固缩。胶质细胞肿胀,核内染色质溶解,核膜不清。血管周围足突轻度肿胀、与基膜分离。微管有部分溶解。结论:再灌注损伤早期皮质神经元、胶质细胞、细胞骨架和血脑屏障即发生变化。提示降低脑水肿、保护血脑屏障等脑保护治疗应越早越好。
BACKGROUND: A large number of studies report the morphological changes of the model of global cerebral ischemia-reperfusion injury. However, the changes of the ultrastructure of the cortex at early reperfusion, especially the changes of the blood-brain barrier, have been reported. Objective: To investigate the changes of early cerebral cortex neurons, glial cells and blood-brain barrier in rats with global cerebral ischemia-reperfusion injury and provide a reliable basis for clinical treatment. Design: Randomized controlled experimental study. Unit: Beijing Tiantan Hospital, Department of Neurosurgery, Department of Anesthesiology and Electron Microscopy. MATERIALS: Six Wistar rats were studied at Beijing Institute of Neurosurgery, Capital Medical University from February 2003 to February 2004. Randomly divided into two groups, ischemia reperfusion group (3) and sham operation control group (3). Intervention: Preparation of rat global cerebral ischemia-reperfusion model. At 1 hour after ischemia-reperfusion in ischemia group, brain was taken at 1 hour after operation in sham operation group, and ultrastructure of cortex was observed by electron microscope. MAIN OUTCOME MEASURES: Changes in cortical ultrastructure. Results: In the early stage of ischemia reperfusion (1h), cortical neurons shrink to some extent. Glial swelling, nuclear chromatin dissolution, unclear nuclear membrane. Pterygia slightly swollen around the blood vessels, separated from the basement membrane. Microtubules are partially dissolved. CONCLUSION: The changes of cortical neurons, glial cells, cytoskeleton and blood-brain barrier in early stage of reperfusion injury change. Tips to reduce cerebral edema, protection of the blood-brain barrier and other brain protection treatment should be as soon as possible.