The importance of systemic response in the pathobiology of blast-induced neurotrauma.
The importance of systemic response in the pathobiology of blast-induced neurotrauma.
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DOI：
10.3389/fneur.2010.00151
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发表时间：
2010-01-01
影响因子：
3.4
通讯作者：
Cernak, Ibolja
中科院分区：
文献类型：
--
作者：
Cernak, Ibolja
由于复杂的伤害环境，多种爆炸效应与身体平行相互作用，爆炸引起的神经创伤是由全身、局部和大脑反应引起的独特临床实体。激活自主神经系统；肺、肝等重要器官的压力突然升高；神经内分泌免疫系统的激活和激活是对大脑分子变化和级联损伤机制做出重大贡献的最重要机制之一。据推测，迷走神经介导的大脑效应在对爆炸的早期反应中发挥着至关重要的作用：这一假设得到了实验的支持，其中双侧迷走神经切断术减轻了心动过缓、低血压和呼吸暂停，并且还防止了暴露于爆炸的动物大脑中过度的代谢改变。临床经验表明特定的爆炸-身体-神经系统相互作用，例如（1）通过爆炸波直接穿过颅骨或引起头部加速和/或旋转与头部直接相互作用； (2)通过水力相互作用，当爆炸超压压迫腹部和胸部时，将其动能转移到身体的液相中，引发振荡波，穿过身体到达大脑。越来越多的证据表明，炎症在爆炸引起的长期神经功能缺损的发病机制中发挥着重要作用。其中包括记忆力下降、运动功能和平衡障碍以及行为改变等。对遭受爆炸的动物使用刚性身体或头部保护的实验表明，头部保护无法预防大脑炎症或减少神经缺陷，而身体保护成功地减轻了爆炸引起的大脑功能和形态损伤。
Due to complex injurious environment where multiple blast effects interact with the body parallel, blast-induced neurotrauma is a unique clinical entity induced by systemic, local, and cerebral responses. Activation of autonomous nervous system; sudden pressure increase in vital organs such as lungs and liver; and activation of neuroendocrine-immune system are among the most important mechanisms that contribute significantly to molecular changes and cascading injury mechanisms in the brain. It has been hypothesized that vagally mediated cerebral effects play a vital role in the early response to blast: this assumption has been supported by experiments where bilateral vagotomy mitigated bradycardia, hypotension, and apnea, and also prevented excessive metabolic alterations in the brain of animals exposed to blast. Clinical experience suggests specific blast-body-nervous system interactions such as (1) direct interaction with the head either through direct passage of the blast wave through the skull or by causing acceleration and/or rotation of the head; and (2) via hydraulic interaction, when the blast overpressure compresses the abdomen and chest, and transfers its kinetic energy to the body's fluid phase, initiating oscillating waves that traverse the body and reach the brain. Accumulating evidence suggests that inflammation plays important role in the pathogenesis of long-term neurological deficits due to blast. These include memory decline, motor function and balance impairments, and behavioral alterations, among others. Experiments using rigid body- or head protection in animals subjected to blast showed that head protection failed to prevent inflammation in the brain or reduce neurological deficits, whereas body protection was successful in alleviating the blast-induced functional and morphological impairments in the brain.