脑水肿的发病机理及药物治疗-1.pptxVIP

脑水肿的发病机理及药物治疗医院及讲者信息脑水肿脑实质聚集过量液体脑水肿分类血管源性脑水肿血脑屏障受损所致，大量液体和血管内蛋白质积聚于脑白质细胞间隙常见于脑创伤、脑出血、脑缺血的第二阶段脑水肿分类细胞毒性脑水肿ATP失功、细胞内外Na+转运失衡所致水肿液分布于脑细胞内，细胞间隙不但不扩大，反而缩小常见于脑缺血和肝衰脑水肿动物实验模型冻伤模型液压冲击伤模型脑出血模型水中毒模型肝损模型The Cold Injury Model冻伤模型主要用于血管源性脑水肿的试验模型冻伤直接破坏血管细胞，导致不可逆的血脑屏障损伤特点：试验的可重复性及受伤面积的准确性Cold injury is performed byinflicting freeze stimulation on the hemisphere of the skull of the animalAfter cold injury, BBB disruption is indicated by evaluating extravasation of Evans blue dyeThe Cerebral Hemorrhage Model通过脑实质内注射胶原蛋白酶破坏血管基底膜或者注射自体血制备脑出血模型（ICH model）常见的蛛网膜下腔出血模型（SAH model）包括：单侧出血、双侧出血、血管内穿刺模型可同时观察到血管源性脑水肿及细胞毒性脑水肿BBB breakdownBBB dysfunctionthrombin and hemoglobin extravasation inflammatory responsesThe Water Intoxication Modelinduces a relative decrease of extracellular Na+ concentration， best reflects simulation of hyponatremiaproduced by intraperitoneal loading of excessive distilled water corresponding to 10%–40% of the body weight of experimental animalsadopted as a model of cytotoxic edema.The Liver Failure Model急性或慢性肝细胞失功引发的肝衰会诱导肝性脑病，造成中枢神经组织严重失功。急、慢性肝衰导致的脑水肿发病机制不同急性肝衰，ICP上升；慢性肝衰很少观察到ICP上升肝衰模型产生的脑水肿为细胞毒性脑水肿星形细胞肿胀血脑屏障未见损害一般采用硫代乙酰胺诱导肝细胞损伤氨基半乳糖诱导急性肝衰胆管结扎或门腔静脉吻合术诱导慢性肝衰评估脑水肿方法干湿称重法重量法MRI检测法Wet-Dry Weight Methoda common and simple methodinvasive and not performed in patientsbased on the weight measurement of brain tissue before and after complete dehydrationWater content (%) = 100× (wet weight ? dry weight) /wet weightWater content = (wet weight ? dry weight)/dry weight Tissue swelling (%) = 100× (final wet weight ? initial wet weight) /initial wet weightwet weight：The weight before dehydrationdry weight：the weight after dehydrationThe Gravimetric MethodThe gravimetric technique is based on calculating the percentage of water from measuring the density of the tissue in experimental animalsThis method is also invasive and not performed in patientsAdvantages:higher sensitivityuse of smaller pieces of tissueMagnetic Resonance Imaging (MRI)a noninvasive method，used for evaluating bra