缺血对神经血管单元的损伤与临床意义-万琪教授ppt课件

1、万 琪 南京医科大学第一附属医院神经内科 ;75 75 岁，男性，因突发左侧肢体岁，男性，因突发左侧肢体无力而无力而2 2月月1616日住院，日住院，2424日复查日复查CTCT显示右显示右MCAMCA梗死，梗死，3 3月月1 1日患者日患者出现嗜睡，呕吐和血压升高，出现嗜睡，呕吐和血压升高，3 3月初月初CTCT显示梗死区渗血，显示梗死区渗血， 经过经过积极处置，患者病情逐渐改善，积极处置，患者病情逐渐改善，认识转清，以下图是认识转清，以下图是3 3月底头颅月底头颅的的CTCT复查情况。复查情况。; History of BBB1885, Paul Ehrlich demonstrated

2、that vital dyes injected into the circulatory system stain all organs of the mammalian body except the brain and spinal cord .1913,Edwin Goldmann, by injecting trypan blue directly into the cerebro-spinal fluid, which stained all central nervous system(CNS) and none of the peripheral organs, suggest

3、ing the presence of a barrier between the CNS and the circulation.;The Neurovascular Unit.A conceptual framework, the neurovascular unit comprises neurons, the microvesselsthat supply them, and their supporting cells. Cerebral microvessels consist of theendothelium (which forms the bloodbrain barrie

4、r), the basal lamina matrix, and theend-feet of astrocytes. Microglial cells and pericytes may also participate in the unit.Communication has been shown to occur between neurons and microvessels throughastrocytes. -2003;The ultrastructure of cerebral capillaries observed with electron microscopy. ;脑缺血再灌注对血脑屏障构造和功能的影响A、正常脑微血管、正常脑微血管 B、局灶性脑缺血后、局灶性脑缺血后 内皮细胞通透性添加内皮细胞通透性添加C、白细胞黏附受体表达、白细胞黏附受体表达 介导白细胞黏附与移行介导白细胞黏附与移行D、基底膜断裂、基底膜断裂 BBB完好性破坏完好性破坏Advances in the Vascular Pathophysiology of Ischemic StrokeGregory J. Thrombosis Research 98 (2000) V73V81;神经血管单元损伤时防治的能够战略脑血管内皮细胞的维护脑血管内皮细胞的维护减轻减轻BBBBBB的渗出或破坏