Brain injury in canine models of cardiac surgery.
Brain injury in canine models of cardiac surgery.
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DOI：
10.1097/nen.0000000000000134
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发表时间：
2014-12
影响因子：
3.2
通讯作者：
Troncoso JC
中科院分区：
文献类型：
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作者：
Blue ME;Wilson MA;Beaty CA;George TJ;Arnaoutakis GJ;Haggerty KA;Jones M;Brawn J;Manmohan S;Lange MS;Johnston MV;Baumgartner WA;Troncoso JC
采用低温(18℃)停循环(HCA)和体外循环(CPB)的犬模型，观察其神经病理和神经功能损害。成年犬分别接受2小时(n=39)、1小时(n=20)或标准体外循环(n=22)，存活时间分别为2小时、8小时、24小时或72小时。HCA后2小时的神经损伤和神经病理比HCA或CPB后1小时严重得多；组织病理学和神经功能缺失评分显著相关。海马齿状回颗粒细胞最早于伤后2小时开始出现细胞凋亡。CA海马区杏仁核和锥体神经元的坏死进展较慢，最严重。在HCA后1小时，神经元损伤最小，但1只存活到72小时的狗海马区出现实质性坏死，这表明存活时间越长，损伤越严重。尽管CPB后神经元损伤很小，但我们在海马区和尾状核区观察到罕见的凋亡和坏死神经元。这些结果对人类体外循环有重要意义，并可能有助于解释患者在体外循环后经历的微妙认知变化。
Neuropathology and neurologic impairment were characterized in a clinically relevant canine model of hypothermic (18°C) circulatory arrest (HCA) and cardiopulmonary bypass (CPB). Adult dogs underwent 2 hours of HCA (n = 39), 1 hour of HCA (n = 20), or standard CPB (n = 22) and survived 2 hours, 8 hours, 24 hours or 72 hours. Neurologic impairment and neuropathology were much more severe after 2-hour HCA than after 1-hour HCA or CPB; histopathology and neurologic deficit scores were significantly correlated. Apoptosis developed as early as 2 hours after injury and was most severe in the granule cells of hippocampal dentate gyrus. Necrosis evolved more slowly and was most severe in amygdala and pyramidal neurons in CA hippocampus. Neuronal injury was minimal up to 24 hours post-1-hour HCA, but 1 dog that survived to 72 hours showed substantial necrosis in the hippocampus, suggesting that with longer survival time the injury was worse. Although neuronal injury was minimal after CPB, we observed rare apoptotic and necrotic neurons in hippocampi and caudate nuclei. These results have important implications for CPB in humans and may help explain the subtle cognitive changes experienced by patients after CPB.