摘要目的 已证实尼莫地平液灌洗可缓解蛛网膜下腔出血(SAH)后脑血流速度的异常增高,现拟研究其对SAH所致异常脑血流灌注的影响.方法 14头雄性小型实验猪随机分为假手术组、SAH组和灌洗组.开颅向鞍上池注入5 ml自体股动脉血制备SAH模型,4 d后用40 ml尼莫地平稀释液(0.04 mg/ml)灌洗灌洗组蛛网膜下腔.30 min后行CT/SPECT扫描,图像经重建断层、对齐及空间标准化后于CT模板绘制感兴趣区再与对应层面SPECT图像配准计算大脑小脑比(CCR)和相对离散度(RD)以半定量描述右侧大脑半球血流量和血流分布异质性.结果 假手术组、SAH组和灌洗组CCR分别为1.988±0.346、1.382±0.192和1.503±0.107;RD分别为0.389±0.015,0.417±0.015和0.425±0.018.SAH组CCR和RD与假手术组差异有统计学意义(P<0.05);灌洗组CCR和RD均与SAH组差异无统计学意义(P>0.05),提示尼莫地平灌洗对SAH所致的半球血流量下降及脑血流分布异质性增加无显著缓解作用.结论 尼莫地平灌洗不能缓解SAH后异常脑血流灌注的机制尚不明确,可能与难以缓解SAH引起的脑微循环障碍有关.

abstractsObjective Base on confirmed efficacy to reduce pathological elevation of arterial blood velocity in SAH model, aiming to explore whether nirnodipine irrigation into subarachnoid space in SAIl model can indeed ameliorate abnormal perfusion status due to delayed vasosposm. Method 14 male minipigs were arranged into Sham, SAH or SAH + nimodipine groups randomly. SAH was manipulated with 5 ml autologous blood from femoral artery which was injected into its suprasellae cistern after craniotomy.40 ml Nimodipine dilution(O.04 mg/ml) was used to irrigate subaraehnoid space for SAIl + nmodipine group at the fourth days after model construction. Thirty minutes after irrigation, CT/SPECCT scans were acquired and the images were spatially normalized to template for perfusion analysis after reconstruction and realignment. ROI had been delineated on the CT template then register them onto corresponding normalized SPECT images, for CCR and RD calculation to senti-quantity hemisphere CBF and perfusion heterogeneity. Results Hemisphere hypoperfusion and more heterogeneous perfusion due to SAH were confirmed by CCR(1.988±0. 346 versus 1.382 ±0. 192, P<0. 05) and RD(0.389 ±0. 015 versus 0.417±0. 015, P < 0.05) comparison between Sham and SAH group. Yet nimodipine irrigation had no effect to ameliorate abnormal perfusion status by CCR(1.503 ±0. 107 versus 1.382 ±0. 192, P >0. 05) and RD(0. 425 ±0. 018 versus 0.417 ±0. 015, P > 0.05) comparison between SAH + nimodipine and SAH group. Conclusions Nimodipine irrigation over intracranial arteries of SAH pigs can not improve cerebral perfusion abnormality.